Claims Specialist

Overview:

Coordinates the process of claims for all lines of business coverage (medical, dental and vision) and coordinating payment to both members and providers of health services. This position will perform such activities as: processing claims, answering phone calls from members and providers, responding to member and provider email inquiries, claims research

Duties and responsibilities:

The Claims Customer Service Specialist will be responsible for the process of claims and customer service inquiries which includes, but is not limited to:

· Ability to directly educate and respond to telephone and written inquiries from providers and members regarding plan benefits, eligibility and claims determination for all lines of business (medical, dental and vision).

· You will provide and assist with research for processes and resolution to inquiries and other related claim correspondence

· Maintain company’s processing goals of 80 claims a day processed within 15 business days of receipt

· Respond and research online inquiries received from the member portal and/or the help site

· Research and write up refund requests and letters of correspondence

· Educates members and providers on the Claimlinx Process

· Assign activities, tasks, inquiries, issues or updates on CRM (Customer Relationship Management System)

· Ability to demonstrate a willingness to commit time and effort to increase professional development

Qualifications:

This position requires an extreme organizational skill set with focus on detail and problem solving capabilities. This position interacts daily with members and providers both on the phone and via electronic media. Focuses on positive customer service experience with the ability to present a professional appearance both on the telephone, in person and through electronic media.

Exhibits strong problem solving and research skills.

Education & Skill Requirements include:

· High school graduate, some college preferred

· At least 2 years in a business environment

· Healthcare Industry knowledge with the capability of understanding insurance terminology

· Must be able to understand claims terminology, medical billing and coding experiece a plus

Abilities:

· Career minded & self-motivating

· Excellent customer service skills

· Excellent communication skills

· Able to work in a fast paced environment

· Professional appearance and demeanor

· Ability to handle sensitive information and maintain a high level of confidentiality

· Experience with data manipulation for importing & exporting information

· Ability to trouble shoot, research & problem solve

· Organization, attention to detail, flexibility and strong ability to multi-task

· Ability to work without direct supervision and demonstrate initiative

Technology Requirements:

· Microsoft Office Products (Excel, Word, PowerPoint & Access)

· CRM (Customer Relationship Management System)

· Basic knowledge of use of the email system, phone system, fax, computer copier etc.

Job Type: Full-time

Pay: $40,000.00 - $45,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to Commute:

• Blue Ash, OH 45242 (Preferred)

Ability to Relocate:

• Blue Ash, OH 45242: Relocate before starting work (Preferred)

Work Location: In person

Salary : $40,000 - $45,000