Lead Claims Specialist

UHS•Reno, NV

About The Position

Job Summary: The Lead Claim Specialist is the first point of contact for the Claims team. Responsibilities include fielding and answering inquiries about processing commercial, ASO and Medicare claims to ensure quality service is being delivered to health plan members, employer groups, brokers, insurance carriers, and provider offices. This role will also promote quality, superior customer service, and will identify enhancements and changes to workflow processes to increase efficiencies, effectiveness and productivity. Will provide on-going feedback to the Claims Supervisor of what is working and where there are areas of improvement/growth.

Requirements

Associate’s degree or equivalent experience
3 years of Insurance claims processing experience
2 years’ experience working with health plans insurance products or employer healthcare benefits programs
Knowledge of State and Federal regulations as they pertain to the health insurance industry
Possesses strong/broad understanding of the claims analyst process, medical/dental terminology, and claims processing procedures
Superior Customer Service skills --- seeks to understand expectations of internal and external customers. Knows which questions to ask and what information to verify to get to the root cause of a problem
Ability to communicate clearly and professionally in English, both verbally and in writing with both internal/external customers
Excellent presentation skills and ability to conduct effective meetings and training sessions
Strong time management, organizational, analytical, and problem-solving skills
Intermediate proficiency with Microsoft Office (Word, Excel, PowerPoint, Outlook)
Takes initiative to research, resolve processing and system issues using available resources without direction. Diligently follow-ups with Director, peers, other departments, and customers
Oriented toward continuous improvement offering ideas and solutions to change or enhance processes or system obstacles; ability to organize and document workflows and processes
Results orientated with an understanding of where tasks and assignments fall into the big picture and organizes and prioritizes accordingly. Gets more out of few resources
Must be able to work in environment with shifting priorities and to handle a wide variety of activities and confidential matters with discretion
The ability to handle confidential or sensitive information with discretion.

Responsibilities

Fielding and answering inquiries about processing commercial, ASO and Medicare claims
Promote quality, superior customer service
Identify enhancements and changes to workflow processes to increase efficiencies, effectiveness and productivity
Provide on-going feedback to the Claims Supervisor