Claims & Eligibility Specialist

the accel group•Moline, IL

2d•Onsite

About The Position

Our RJ Lee office in Moline specializes in benefits consulting and administration in the Union/Taft-Hartley arena, and we are seeking a Claims & Eligibility Specialist to join our team. In general, this person will be responsible for providing customer service to members as it relates to their health insurance plans, assisting with the administration of those health plans, and handling associated claims for the health plans.

Requirements

High school diploma or equivalent.
Previous customer service experience.
Previous experience with medical insurance, benefit plan administration, medical claims processing, and/or third-party administration.
Basic knowledge of medical insurance with the ability to answer plan and coverage questions.
Strong attention to detail and accuracy in work.
Excellent customer service skills, including the ability to have positive customer interactions and maintain positive customer relationships.
Excellent computer skills, including the ability to utilize Microsoft programs (Outlook, Word, and Excel), web-based computer applications, and other agency management systems.
Excellent time management and organizational skills, including the ability to handle multiple projects or tasks, meet established deadlines, and change priorities as business needs require.
Excellent communication and interpersonal skills, including both written and verbal communication.
The ability to work collaboratively in a team environment, but also independently with minimal daily supervision.
The ability to utilize basic office equipment, such as a computer, keyboard, mouse, monitors, printer, copier, and scanner.

Nice To Haves

Additional experience with Taft-Hartley plans is helpful, but not required.
Basic accounting experience is also helpful, but not required.

Responsibilities

Process weekly disability claims
Answer member questions related to their eligibility, benefits, coverage, and/or claims
Prepare and distribute health plan information to members
Prepare and mail COBRA notices to members
Act as a liaison between members and the pharmacy benefit manager as it relates to prescription claims
Verify coverage and provide claim status updates to providers
Record daily deposits and self-pays from members
Transfer funds from accounts as necessary to pay claims and liabilities of funds
Prepare and reconcile monthly reports for appropriate plans
Prepare monthly, quarterly, and annual tax returns
Reconcile monthly bank statements and Quick Book reports
Prepare monthly annuity report and complete wire transfer each month
Track monthly and quarterly invoices
Prepare participation and retiree billing
Prepare financial reports for quarterly trustee meetings
Maintain proper documentation and accurate records related to the administration of the health plans and corresponding claims. This includes (but is not limited to) member eligibility and participation records, member communications, claim statuses and payments, billing, pension payroll files, etc.
Assist with reception, telephone answering, and other office functions as needed