Claims Correspondence Review Specialist

Position Location: 100% remote

Responsibilities

• Understand and review claims processing.
• Interpret plan documents.
• Review, research, and analyze information to determine eligibility.
• Perform outbound telephone calls to assist in obtaining the required information to process a claim.
• Work with the Claims Examiner to resolve claims processing issues.
• Receive, review, and respond to inquiries regarding plan documents, benefits, and claims.
• Review and respond to emails in a timely manner.
• Manage emails in shared mailboxes and group-specific mailboxes and provide acknowledgement and resolution to email questions within 8 hours or provide the customer with an ETA and explanation for delay.
• Review and respond to Freshdesk tickets in a timely manner.
• Respond to and resolve urgent issues in a timely manner.
• Regularly check and prioritize voicemails on an hourly basis and reply in a timely manner, no more than 8 hours.
• Act as a role model in demonstrating the core values in customer service delivery.
• Provide timely and thorough follow up with internal customers and appropriate parties.
• Track and return telephone calls/mail to members and groups answering specific plan or claim questions within 24 hours.
• Appropriately escalate difficult issues up the chain of command.
• Recognize and alert appropriate supervisor of trends within their scope of responsibility that fall outside of quality parameters.
• Collaborate with others and cross-departmentally to improve or streamline procedures.
• Perform self-quality monitoring to develop and execute plans to meet established goals.

Requirements

• High school diploma or equivalent.
• Two years of claims examiner and/or customer service experience.
• Proficient 10-key and typing skills.
• Working knowledge of computers and software including but not limited to Microsoft Office products.
• Demonstrated organizational skills, problem-solving skills, analytical skills, and attention to detail.
• Strong written, oral, and telephonic communication skills with attention to detail and accuracy.
• Demonstrated ability to work independently, prioritize workloads, and multi-task.
• Demonstrated ability to work in a fast-paced environment while maintaining accuracy and production requirements.
• Demonstrated ability to remain neutral and maintain confidentiality.

Physical Requirements

• Work is indoors in an office environment with moderate noise.
• Intermittent physical effort involving lifting of up to 25 pounds, walking, and stooping, kneeling, crouching, or crawling is required.
• A typical workday involves sitting, frequent use of a keyboard, reaching with hands and arms, and talking and hearing, approximately 70% of the time.
• Approximately 30% or less of the time is spent standing.
• Normal vision abilities required, including close vision and ability to adjust focus.

Benefits

• Multiple Health Plan Options, including a 100% Employer Paid Benefit Options.
• 100% Company paid employee premiums for Dental, Vision, STA, & LTD, plus Life Insurance.
• Parental Leave Policy.
• 20 days PTO to start / 10 Paid Holidays.
• Tuition reimbursement.
• 401k Company contribution.
• Professional development initiatives / continuous learning opportunities.
• Opportunities to participate in and support the company's diversity and inclusion initiatives.