Claim Benefit Specialist

Position Summary

Attendance during the 21 week training period is required. Applicants must reside in the Eastern Standard time zone (EST).

Responsibilities

• Reviews and adjudicates claims in accordance with claim processing guidelines.
• Enhances and improves member satisfaction and retention by providing accurate and timely resolution in processing medical claims.
• Keeps a key link in providing prompt, efficient, high quality claim service.
• Determines and understands the coverage provided under a member's health plan.
• Efficiently uses multiple systems and screens to obtain and record claim information.
• Reviews claims information to determine the nature of a member's illness or injury.
• Identifies claim cost management opportunities and refers claims for follow up.
• Makes claim payment decisions.
• Processes claims accurately to enhance customer satisfaction and retention.
• Processes claims within quality and production standards.
• Affords assistance to team members in support of achieving team, office, regional, and national goals.

Requirements

• Experience in a quality and production environment.
• Attention to detail.
• Ability to use multiple computer applications at one time.
• Claim processing experience.

Qualifications

• Desired Qualifications: Detail oriented individual who enjoys working in a team environment and can create value for our customers by exceeding high quality metrics. 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. 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.

Benefits

The Typical Pay Range For This Role Is $17.00 - $28.46. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.