Description
We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.
As a Claim Benefit Specialist, you will perform claim documentation review, verify policy coverage, assess claim validity, communicate with healthcare providers and policyholders, and ensure accurate and timely claims processing.
Responsibilities
- Handles and processes benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines.
- Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope.
- Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements.
- Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims.
- Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution.
- Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims.
- Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies.
- Analyzes claims data and generates reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department.
Position Summary
- This is a Claim Benefit Specialist position and will be trained for 20 weeks virtually.
- Shift hours: Flex schedule available after successful ramp up.
Requirements
- 1-2 years experience working in Customer Service.
- Possess strong teamwork and organizational skills.
- Strong and effective communication skills.
- Ability to handle multiple assignments competently through use of time management, accurately and efficiently.
Preferred Qualifications
- Experience in a production environment.
- Healthcare experience.
- Knowledge of utilizing multiple systems at once to resolve complex issues.
- Claim processing experience preferred but not required.
- Understanding of medical terminology.
Benefits
- Medical, dental, and vision coverage.
- Paid time off.
- Retirement savings options.
- Wellness programs.