Job Description
This is a work from home opportunity for candidates based in the EST time zone.
Schedule:
Training Schedule: 20-21 weeks ( NO PTO during training)
Shift Schedule: EST 8:am- 4:30pmEST
We are looking for a detail oriented individual who enjoys working in a team environment and can create value for our customers by exceeding high quality metrics.
-Reviews and adjudicates claims in accordance with claim processing guidelines.
-Claim Benefit Specialists have the opportunity to enhance and improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims.
-You will be a key link in providing our customers with prompt, efficient, high quality claim service.
-Determine and understand the coverage provided under a member’s health plan.
-Efficiently use multiple systems and screens to obtain and record claim information.
-Review claims information to determine the nature of a member’s illness or injury.
-Identify claim cost management opportunities and refer claims for follow up.
-Make claim payment decisions
-Process claims accurately to enhance customer satisfaction and retention.
-Process claims within quality and production standards
-Assist team members in support of achieving team, office, regional, and national goals
Pay Range
The typical pay range for this role is:
Minimum: 17.00
Maximum: 27.90
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
-The ideal candidate will have exceptional analytical skills, accurate and fast keyboarding skills, advanced computer navigation and knowledge and experience in a Windows environment, effective verbal and written communication skills, the ability to adapt quickly and willingly to change, and a positive, willing attitude.
-Prior medical claim processing experience is a plus.
-Successful candidates should be comfortable with quality goals, production goals, and service expectations and will be monitored for accuracy, efficiency, and customer satisfaction.
-Comprehensive training will be provided to assist in the achievement of these objectives. Attendance during the 20 week training period is required. After completion of the training period, overtime may be required based on business needs.
Preferred Qualifications
See above
Education
Associate’s degree preferred; High School diploma required