Insurance Claims Specialist

Illinois  ‐ Onsite
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Keywords

Description

Assist clients with the claim, appeal, inquiry, and/or complaint process. Conducting research and make determinations on Claims and provide research to clients for Appeals. Work on multiple clients while researching, analysing, and making a determination on each participant issue using plan documents and guidelines. Draft and mail an individualized response letter to the plan participant.

Responsibilities include:
  • Process claims, appeals, inquiries, and complaints for a group of clients.
  • Complete their assigned claims and appeals within ERISA timeframes.
  • Research claims and appeals using a number of resources such as: TBA, CPro, Imaging, Lotus Notes databases, client plan documents, and client guidelines.
  • Interact with the Client, Benefit Center, Plan Management, Advocacy, Connections, Health Plans, and Providers.
  • Handle incoming calls related to Concurrent and Urgent Care claims and appeals on a rotational schedule.
  • Maintain high levels of confidentiality.
  • Work to achieve certification, if not already certified.
  • Shows initiative and positive attitude.
  • Developing Subject Matter Expertise.

SKILLS:

  • College degree preferred but not required
  • One or more years experience in handling and resolving complex client escalation issues
  • Experience on a multi-client/multi-service team is a plus but not required
  • Some legal background a plus but not required
  • Strong working knowledge of Workstation functionality
  • Solid verbal and written communication skills, including solid business writing skills required
  • Multitasking and time management
  • Problem solving, research skills, attention to details
  • Windows XP, Lotus Notes, Word, Excel, PowerPoint
  • Legal Requirements, Health Plans and Connections
  • HIPPA, ERISA, COBRA, Section 125, and DOL regulations, and several types of benefits
  • Ability to work first shift and third shift several times a month
  • Ability to work effectively in a dynamic environment
  • Must be able to work independently as well as collaboratively in a team environment
Start date
n.a
From
Synectics
Published at
14.11.2013
Project ID:
627183
Contract type
Freelance
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