Medical Claims Specialist

CNSCares•Las Vegas, NV

2h•Onsite

About The Position

On behalf of CNS Cares, LLC (“CNS” or “Company”), this position is responsible for developing relationships with leads and claimants, associated retiree groups, physicians, authorized representatives, agency personnel, and other various stakeholders associated with the EEOICPA program and other programs as required. The position will provide assistance to claimants by guiding them through the claim filing process, determining potential benefits under the EEOICPA or other identified programs, and assisting in gathering work history and medical records. The role involves helping claimants file initial claims and refile denied claims, informing them of available resources, and maintaining professional communication with internal and external customers. The Medical Claims Specialist will also maintain industry knowledge, identify process improvements, and liaise with health service agencies. Occasional attendance at outreach events may be required.

Requirements

High school Diploma or GED.
At least two (2) years of related program or clinical/medical experience and/or training.
Knowledge of DOL EEOICPA program, knowledge of the EEOICPA application process, specifically the records necessary for any potential claimant to file a claim under the EEOICPA.
Knowledge of medical terminology and the ability to translate terminology into verbal and written communication.
Valid Driver’s License
Criminal background check
Driving Record check
OIG Exclusion List check
Sex Offender Registry check

Nice To Haves

Certified Medical Assistant (CMA) certification or Licensed Practical Nurse (LPN) preferred, but not required
At least one (1) year of specific DOL EEOICPA program experience.

Responsibilities

Provide assistance to claimants as needed, by guiding claimants through the claim filing process, and supporting in other ways as needed.
Determine what benefits these individuals may qualify for under the EEOICPA or other identified programs.
Assist in research and gather work history and medical records as necessary.
Help claimants file initial claims and refile claims that have been denied.
Inform individuals of the resources available that may assist their claim process and overall health and wellness.
Answering & returning frequent phone calls/emails in a polite & timely manner with internal and external customers.
Maintains industry knowledge by participating in educational and training opportunities.
Assists in identifying efficiencies and improving processes.
Maintains contact with professionals of various health service agencies, after obtaining a Release of Information, to determine Claimant eligibility services.
Occasionally will attend outreach events as needed.
Other duties as assigned.