Trades Medical Benefit Specialist

Valeris • Remote, North Carolina, NC

57d

About The Position

The Medical Claims Specialist works directly with provider offices using Valeris medical benefit copay programs. The role helps address inquiries about submitting medical claims, troubleshoot issues, investigate claim status, and confirm payment receipt. The specialist also works with outside vendors responsible for stages of the claim journey to troubleshoot escalations and resolve provider concerns.

The position manages daily program activities and escalations, supports stakeholders and pharmaceutical representatives, and serves as a focal point for provider claim escalations. It requires investigating medical claim scenarios, communicating with providers, patients, vendors, and internal stakeholders, maintaining compliant records and confidentiality, and contributing to program improvements. The role operates in a professional office environment and uses standard office equipment.

Requirements

• Associate or bachelor's degree preferred, or at least 5 years of customer service or medical claim experience.
• Ability to provide exceptionally articulate verbal and written communication.
• Proficiency with Microsoft products, including MS Excel, and ability to review data sets to reach conclusions.
• Ability to directly support and liaise between client-facing teams and technology and operational delivery teams.
• Ability to manage and prioritize workload amid competing demands.
• Ability to collaborate with users to articulate requests and issues and deliver timely resolutions.
• Proven problem-solving ability and strong organizational skills to manage varied escalations.
• Logical, efficient work style, attention to detail, and committed follow-through in communication with stakeholders.
• Willingness to work in a dynamic, fast-paced environment and ability to multitask across multiple escalations.
• Strong interpersonal skills and ability to work independently and as part of a team.

Nice To Haves

• Strong understanding of medical claims processing, rejection troubleshooting, reversals and adjustments, and provider medical claims workflows.
• Experience managing vendors, contractors, or subcontractors.
• Ability to type at least 35 words per minute with 97% accuracy.
• Flexibility to travel as needed.

Responsibilities

• Manage day-to-day activities and escalations for assigned medical benefit copay programs.
• Act as an advocate for stakeholders by providing detailed information about medical claim situations.
• Serve as the focal point for provider medical claim escalations.
• Conduct verbal and written outreach to provider sites, patients, and other stakeholders associated with supported programs.
• Provide customer service as a service representative.
• Analyze situations, interpret information, draw conclusions, and decide appropriate actions.
• Support pharmaceutical representatives with their sites as needed regarding medical benefit programs.
• Use an understanding of end-to-end medical claim processes to investigate scenarios and determine resolutions.
• Maintain ethical conduct regarding confidentiality and privacy.
• Maintain records in accordance with applicable standards and program regulations.
• Evaluate programs and promotions and recommend new tools, forms, and procedures.
• Participate in program team meetings and current and future improvement initiatives.
• Collaborate with external vendors and internal stakeholders to document, escalate, and resolve issues.
• Participate in continuing education to remain knowledgeable about programs, promotions, and related areas.

Benefits

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs.
• Telehealth and Employee Assistance Program services.
• Company match on Health Savings Account contributions.
• Free basic life and AD&D coverage equal to annual earnings, with a minimum of $50,000 and a maximum of $300,000.
• Company-paid short-term disability coverage, with the option to purchase long-term disability.
• 401(k) Retirement Savings Plan with 100% match on the first 5% contributed and immediate vesting.
• Paid Time Off (PTO) and sick leave.
• Nine paid holidays plus two floating holidays.
• Opportunities for advancement and personal and professional growth.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree