Hybrid Claims Support Specialist II

Posted 3 weeks ago

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About the role

  • Gather information (via phone, fax, or e-mail) that is necessary for claim adjudication
  • Review new claims for eligibility requirements, creates and sends claimant letters, and communicates with claimants, brokers, plan administrators, or physicians to obtain information necessary to triage claims to a Claims Specialist
  • Completes requests assigned by Claims Specialist to obtain medical documentation and coordinates payment for records when necessary
  • Independently manage worklist and complete tasks within established turn-around time expectations
  • Communicate effectively across multiple channels, including phone, e-mail, and letter
  • Follow outlined steps in a checklist or workflow with a high degree of accuracy and consistency
  • Communicate clearly with outside partners such as physicians’ offices and other vendors
  • Accurately summarize large quantities of medical information and data into actionable, usable data summaries
  • Make basic claims decisions based on the information available to them and adherence to established workflows
  • Participates and contributes to team meetings or special tasks and assignments and brings innovative ideas and a continuous improvement mindset to the department
  • Consistently supports and promotes change management and/or departmental/enterprise initiatives within assigned area(s) of responsibility
  • Fosters strong partnerships and collaborates with key internal areas, such as Claims, Compliance/Legal, Support Services, Intake/Admin, etc.

Requirements

  • Strong communication skills – both written and verbal – including the ability to anticipate and address next questions/root cause
  • Ability to communicate effectively in a customer-centric and professional demeanor
  • Demonstrated ability to use sound judgement and discretion regarding confidential information
  • Process improvement mindset – ability to identify trends and suggest process improvements to deliver an improved level of customer experience
  • Willingness to accept coaching, and ability to provide coaching and feedback to peers, teammates, and leaders

Benefits

  • Your Benefits Start Day 1
  • Prioritization of your health and well-being including Medical, Dental, Vision, and Wellbeing Reimbursement Account that can be used on yourself or your eligible dependents
  • Generous paid time off options including: Paid Time Off, Holiday Schedules, and Financial Planning Time Off
  • Paid Parental Leave as well as an Adoption Assistance Program
  • Competitive 401k savings plan with company match and an additional contribution regardless of participation

Job title

Claims Support Specialist II

Job type

Experience level

Mid levelSenior

Salary

$20 - $24 per hour

Degree requirement

No Education Requirement

Location requirements

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