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
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