Claims Issue Resolution Professional

CenterWell • Miramar, OH

14h • Remote

About The Position

The Claims Research & Resolution Professional 2 manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claim settlements both for and against the organization. The Claims Research & Resolution Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Claims Research & Resolution Professional 2 works with providers, members, and internal and external payer partners in the settlement of claims. Supports a team that processes claims by researching the resolution to a claims issue inquiry. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Requirements

• Bachelor's degree
• 2 years of technical experience
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Nice To Haves

• Claims processing experience
• Customer service
• Provider engagement

Responsibilities

• Manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization.
• Approves all claim settlements both for and against the organization.
• Works with providers, members, and internal and external payer partners in the settlement of claims.
• Supports a team that processes claims by researching the resolution to a claims issue inquiry.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level