Claims Review Specialist

Amwins•Scottsdale, AZ

13d•Hybrid

About The Position

Join Amwins Self-Funded, LLC. as a Claims Review Specialist. This is an in-office position that offers the flexibility to work from home up to 2 days a week after completing training. At Amwins, we value our team members and offer a range of benefits to enhance your work experience, including a hybrid work environment with flexible scheduling options, a competitive benefits package from day one with generous Paid Time Off (PTO) and paid holidays, a collaborative, education-focused work environment, and an annual performance-based bonus program.

Requirements

A college degree or equivalent work experience is strongly preferred.
Proficiency with Microsoft Office products (Word, Excel, Outlook, and Teams) is preferred.
The ability to critically think and problem-solve.
Ability to maintain strict confidentiality.
Ability to multitask, adjust to changing priorities, and effectively manage time to meet deadlines.
Effective written and verbal communication skills with both internal and external parties.
A sense of urgency and attention to detail are necessities.
Eagerness to learn Stealth’s business model is a necessity.

Responsibilities

Learn Stealth’s Business Model: Understand Amwins Self-Funded business model and the products we support under the guidance of the Claims Manager and Lead Claims Auditor.
Effective Correspondence: Correspond accurately and timely with carriers, administrators, clients, and brokers using approved form letters and emails, with all correspondence copied to the Claims Lead.
Claim Reports Management: Manage monthly claim reports for the administration of the assigned book of business, ensuring forwarding to the appropriate carrier and following up on missing reports.
Reimbursement Request Review: Review submitted reimbursement requests for completeness and request any missing information.
Eligibility Documentation Approval: Obtain approval from the Claims Lead on eligibility documentation noting time-off exceeding twelve (12) weeks before submitting a claim reimbursement request.
Claim Submission and Tracking: Record and submit reimbursement requests to the appropriate carrier within authorized dollar authority, tracking and following up on outstanding payments.
Reimbursement Issuance: Review and issue reimbursements, notifying designated contacts accurately and in a timely manner.
Claim Tracking Logs: Maintain internal claim tracking logs to ensure accurate records.
Year-End Account Closure: Manage the settlement of all reimbursement requests at the end of the plan year to properly close the client’s account.
Adaptability and Team Collaboration: Handle other duties and projects as assigned, showcasing adaptability and strong collaboration skills.