Hybrid Claims Specialist

at Vision Benefits of America

• Job title: Claims Specialist
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $20 - $22 per hour
• Degree requirement: Associate's Degree
• Location requirements: Hybrid, Carnegie, United States

About the role

• Claims Specialist determining reimbursements for out-of-network claims in a remote setting. Collaborating with team members and addressing member inquiries in a fast-paced environment.

Responsibilities

• Review out-of-network claims for completeness of submission.
• Validate member eligibility and policy details through use of Claims system.
• Proficient use of document management technology (Content Server) for securing and storing documents through their lifecycle.
• Works jointly with team members to manage all parts of the reimbursement process (processing claim requests, validation, payment, adjustments, audits and research); tasks can vary daily as assigned.
• Research and respond to escalated member questions regarding out-of-network and adjustments.
• Act as a liaison for member issues including benefit eligibility, claims questions, and customer satisfaction.
• Work with Claims Processing Team Lead and Benefit Relations Teams to resolve member, provider and lab reimbursement and claim inquiries.
• Complete projects as assigned by department lead or other departments.
• Perform activities and functions of related lower-level personnel as assigned or required.
• This is a remote position within the Pittsburgh, PA area. In-office may occur periodically based on business need.
• Work is performed in a home office environment and may require: occasionally lifting 0 – 20 pounds.

Requirements

• Associate degree or equivalent work experience. Bachelor’s degree is preferred.
• At least 2 years of full-time customer service experience.
• 1 year claims processing experience, preferably in a healthcare field.
• Proficient in MS Office Suite – Word, Excel, Outlook and Teams
• Proficiency in insurance plan rules
• Ability to use resources to answer questions and solve problems
• Strong analytical, problem solving and decision-making skills
• Ability to work independently with minimal supervision or cooperatively as part of the team
• Ability to influence and effectively communicate with diverse personalities
• Effective organizational and time management skills
• Ability to work well with all levels of management and staff while maintaining a professional and diplomatic demeanor

Benefits

• Health and Dental benefits with minimal employee contribution.
• Employer paid Vision, Short Term and Long Term Disability, and Life Insurance benefits. Vision plan offers generous allowances, no copays, and two materials per year for eligible employee and dependents.
• 401k employer matching up to 6% following six months of service, vesting after five years of service.
• Generous time off and leave package