Insurance Staff Support Specialist

Forest County Potawatomi Community•Crandon, WI

About The Position

This role involves supporting insurance operations by re-pricing claims, managing databases, preparing reimbursement documents, and handling customer service inquiries. The specialist will also assist with administrative tasks such as check runs, requisitions, and document management.

Requirements

High school diploma or GED
Two (2) years of work experience in a medical office, medical facility, health insurance or employee benefits preferred
Must obtain and maintain HIPAA and Insurance Marketplace CAC certification
Knowledge of medical terminology and health/medical insurance
Skill in operating business computers and office machines, including in a Windows environment, specifically Word, Excel, Access, and PowerPoint
Ability to communicate effectively and represent organization in a professional manner
Must successfully pass all applicable background checks and drug screens

Nice To Haves

Four (4) years of work experience in a medical office, medical facility, health insurance or employee benefits preferred
Experience with Indian Health Service preferred

Responsibilities

Re-price Contract Health Services/Purchased Referred Care eligible claims to the MLR /PRC for hospital and physicians for both internal and external clients.
Re-price employee health claims in their designated PPO software portals.
Assist in the production and distribution of benefit information to members, employees, and clients.
Maintain database of facility CMS Rate Notifications letters and submit to data vendor as needed to ensure accurate re-pricing.
Update and maintain Section 506 Recovery reimbursement data via excel spreadsheets.
Prepare and compile documents for stop-loss and Catastrophic Health Emergency Fund reimbursements.
Update and input pre-certifications and authorizations into claim adjudication.
Identify documents for destruction, maintain destruction schedule, and verify documents are destroyed on site by document destruction vendor.
Print and distribute daily reports and all letters generated by claims examiners.
Answer incoming customer service calls, manage departmental mail posting, sorting and distribution.
Assist walk-in customers promptly and courteously.
Assist Accounting Specialist with in-house check runs and create departmental purchasing requisitions for the Director’s approval.
Type letters, reports, memos and create flyers as requested by supervisor.