Claim Benefit Specialist
About The Position
We are looking for a detail-oriented individual who enjoys working in a team environment and can create value for our customers by exceeding high-quality metrics. The ideal candidate will have exceptional analytical skills, accurate and fast keyboarding skills, advanced computer navigation and knowledge and experience in a Windows environment, effective verbal and written communication skills, the ability to adapt quickly and willingly to change, and a positive, willing attitude. Prior medical claim processing experience is a plus. Successful candidates should be comfortable with quality goals, production goals, and service expectations and will be monitored for accuracy, efficiency, and customer satisfaction. Comprehensive training will be provided to assist in the achievement of these objectives. Attendance during the 21-week training period is required. After completion of the training period, overtime may be required based on business needs. The Claims Benefits Specialist reviews and adjudicates claims in accordance with claim processing guidelines. Claim Benefit Specialists have the opportunity to enhance and improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims. You will be a key link in providing our customers with prompt, efficient, high-quality claim service.
Requirements
- Experience in a quality and production environment.
- Attention to detail.
- Ability to use multiple computer applications at one time.
- Claim processing experience.
Nice To Haves
- Prior medical claim processing experience is a plus.
- Ability to multi-task
- Ability to work independently or as part of a group
Responsibilities
- Determine and understand the coverage provided under a member's health plan
- Efficiently use multiple systems and screens to obtain and record claim information
- Review claims information to determine the nature of a member's illness or injury
- Identify claim cost management opportunities and refer claims for follow up
- Make claim payment decisions
- Process claims accurately to enhance customer satisfaction and retention
- Process claims within quality and production standards
- Assist team members in support of achieving team, office, regional, and national goals
Benefits
- medical coverage
- dental coverage
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
