Claims Benefit & Disability Analyst I

Medical Mutual•Cleveland, OH

2d•Onsite

About The Position

Medical Mutual is seeking applicants that reside within a 50-mile radius of the Brooklyn, Ohio office for the Claims Benefit & Disability Analyst I role. This position requires working 5 days per week on-site in our Brooklyn, Ohio office. Medical Mutual, founded in 1934, is the oldest and one of the largest health insurance companies based in Ohio, providing peace of mind to over 1.2 million members through various high-quality health, life, disability, dental, vision, and indemnity plans. The role involves preparing and establishing new claims files, verifying eligibility and benefit amounts, inputting claim data, responding to customer inquiries, managing mail, and dispatching reports.

Requirements

1 to 2 years experience with disability and/or life claims processing/customer service, preferably in group insurance, or equivalent relevant experience.
Basic Microsoft Office, claims processing/billing/customer service applications, and document storage/workflow (OnBase) application skills.
Knowledge of standard office procedures and equipment (multi-function copier/printer/scanner, conference phone, etc.).
Basic knowledge of life and disability products/services.
Basic knowledge of regulations and Company policies related to leaves of absence, disability, workers compensation, etc.
Basic knowledge of Family and Medical Leave Act (FMLA) and Americans with Disabilities Act (ADA).

Nice To Haves

Bachelors’ Degree in Business or Healthcare Administration or related field preferred.
Equivalent education and experience directly related to the role may substitute for a degree.

Responsibilities

Opens, sorts and distributes mail, checks and files; maintains filing system.
Determines the status of a new or continuing claim.
Sets up claims files in claims system for all life and disability benefit types and distributes work accordingly.
Determines eligibility using CMS claims and leave administration systems.
Sets up all claims in the system with correct benefit schedules, plans, taxation, and interest indicators.
Sets up ACH information.
Prepares a new Short-Term Disability claim file with all relevant documents for the assigned analyst.
Completes claims system setup, document scanning, and worksheets.
Identifies appropriate analyst and claim type.
For life claim: scans documents into claims system and retains original documents.
For Short Term Disability: collects the file and delivers to appropriate analyst.
Responsible for managing the department's email inbox, fax, and incoming customer phone calls from the toll-free number.
Responds to routine customer phone inquiries and emails in the shared department mail queue and routes them to the appropriate individual or area within the organization.
Responsible for department administrative duties that may include departmental scanning projects, ordering supplies and purchase requests, check handling, preparing and mailing monthly, quarterly and annual statements.
Performs other duties as assigned.

Benefits

Laptop, monitors, keyboard, mouse and headset provided.
Access to on-site fitness centers or gym membership reimbursement.
On-site cafeteria.
Discounts at local businesses.
Opportunity to earn cash rewards for shopping with customers.
Business casual attire, including jeans.
Employee bonus program.
401(k) with company match up to 4% and an additional company contribution.
Health Savings Account with a company matching contribution.
Medical, dental, vision, life and disability insurance.
Access to an Employee Assistance Program.
Company holidays.
Up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
Parental leave for eligible employees who become parents through maternity, paternity or adoption (after 120 days of service).
Career development programs and classes.
Mentoring and coaching.
Tuition reimbursement up to $5,250 per year.
Diverse, inclusive and welcoming culture with Business Resource Groups.