Claims Escalation Specialist

Personify Health

121d • $20 - $24

About The Position

Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

Requirements

• High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration or related field preferred.
• Minimum of 2 years’ experience in healthcare claims examination or adjudication.
• Strong knowledge of medical terminology, CPT/ICD-10 coding, and healthcare billing procedures.
• Expertise in multiple claims processing platforms, to include Anthem processing, a plus.
• Prior experience with both manual and automated claims processing.
• Excellent attention to detail and analytical skills.
• Effective verbal and written communication skills.
• Must be able to establish and maintain good working relationship with clients and provide excellent customer service.

Responsibilities

• Maintain quality and procedure standards including complete review and examination of claim situations to ensure proper handling in accordance with company policies and procedures.
• Complete claims task in timely manner and maintain production requirements.
• Review and understand plans, documents and vendors. Ensure proper system setup while processing claims.
• Identify and report to management any potential errors, problems or issues regarding plan documents, claims processing or system setup.
• Manage, resolve and respond to customer-initiated claim escalations, inquiries, or questions while ensuring high customer and/or client satisfaction.
• Perform root cause analysis, identify trends, and work with internal partners to rectify issues and make recommendations for service or process improvements.
• Work stop loss renewal process, as directed by management.
• Complete all training requirements in a timely manner, as directed by management.
• Understand and enforce company procedures, policies and standards.
• Practice good follow up procedures to ensure completion of task and/or inquiries.
• Direct client contact, internal staff and vendor support to ensure customer and member satisfaction.
• Support management team with projects and special requests.

Benefits

• Comprehensive medical and dental coverage through our own health solutions.
• Mental health support and wellness programs designed by experts.
• Flexible work arrangements.
• Retirement planning support.
• Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection.
• Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage.
• Professional development opportunities and clear career progression paths.
• Mentorship from industry leaders.
• Learning budget to invest in skills.
• Unlimited PTO policy.
• Benefits effective day one.

What This Job Offers

• Job Type: Part-time
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees