Claim Benefit Specialist
Job Description:
- Review and rework sensitive, complex medical and hospital claims for the rework project department.
- Work closely with Commercial Services Operations team members to perform root cause analysis and precisely resolve affected claims.
- Ensure rework project claims are resolved accurately and handled by the rework project due date.
- Serve as a medical/hospital claim processor for rework projects, compliance, and complex issues.
- Process claims for specific providers/networks or large-scale rework projects resulting from plan sponsor issues, release fallout, and legal, regulatory, or compliance concerns.
- Interface with appropriate areas to resolve claims.
Requirements:
- Minimum 1 year of experience in medical claims processing, healthcare billing, revenue cycle operations, or a related healthcare administrative role.
- Strong analytical and problem-solving skills with the ability to research and resolve complex claim issues.
- Proven ability to manage multiple priorities while meeting quality and turnaround time expectations.
- Strong attention to detail and commitment to accuracy.
- Proficiency in Microsoft Excel, including sorting, filtering, and basic data analysis.
- Demonstrated ability to work effectively in a fast-paced environment while adapting to changing business needs.
- High School diploma or equivalent
- Experience working in healthcare, insurance, claims processing, medical billing, or customer service.
- Knowledge of medical terminology, insurance benefits, or healthcare operations.
- Experience using computer systems to research and resolve customer or claim-related issues.
- Ability to work independently and collaboratively in a team environment.
- Strong organizational and time management skills.
- Demonstrated adaptability and willingness to learn new processes and systems.
Benefits:
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being, based on eligibility
