What are the responsibilities and job description for the Claims Specialist position at Morgan White Group?
The Claims Specialist plays a vital role in supporting the Department Manager within the TPA Department. This position is located at our Ridgeland, MS office.
Key Job Responsibilities:
- Conduct thorough medical, dental and vision claims adjudications
- Utilize our Policy Administration System and Claims Management Software to verify member eligibility and review accounts
- Input data into our Claims Management Software with precision and accuracy
- Handle incoming mail, provider appeals, and inquiries by reviewing member correspondence and directing it to the appropriate department
- Maintain exceptional customer service by following best practices and responding to customer inquiries
- Perform regular audits on individual and group policies to ensure accurate claims payment
- Protect sensitive information by keeping claims confidential
- Ensure compliance with company policies, procedures, and guidelines to maintain legal standards
- Identify and escalate critical issues to supervisors for prompt resolution
- Meet or exceed performance metrics while staying up-to-date on business processes within Morgan White Group, including internal departments, insurance carriers, brokers/agents, and group contacts
- Pursue other duties assigned by the Department Manager to support team objectives
