Claim Benefit Specialist

About the role

Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills.

Attendance during the 21 week training period is required. After completion of the training period, overtime may be required based on business needs. Applicants must reside in Central Standard Time Zone (CST), Mountain Standard Time (MST) or Pacific Standard Time (PST).

Responsibilities

• Handles and processes claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines.
• Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope.
• Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements.
• Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims.
• Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution.
• Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies.

Requirements

• 1 year of experience in claims, call center, or related customer service experience in Healthcare
• Proficient in computer operations and software applications
• Experience in a production environment
• Ability to performance metrics including production, quality, and turnaround time
• Possess strong teamwork and organizational skills

Preferred Qualifications

• Ability to multi-task
• Ability to work independently or as part of a group

Qualifications

High School diploma or equivalent GED

Schedule

Full time, 40 anticipated weekly hours

Pay

The typical pay range for this role is $17.00 - $28.46 per hour. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

Benefits

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families, including:

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility