Claims Review Specialist

Responsibilities

• Learn Stealth’s Business Model: Understand Amwins Self-Funded business model and the products we support under the guidance of the Claims Manager and Lead Claims Auditor.
• Effective Correspondence: Correspond accurately and timely with carriers, administrators, clients, and brokers using approved form letters and emails, with all correspondence copied to the Claims Lead.
• Claim Reports Management: Manage monthly claim reports for the administration of the assigned book of business, ensuring forwarding to the appropriate carrier and following up on missing reports.
• Reimbursement Request Review: Review submitted reimbursement requests for completeness and request any missing information.
• Eligibility Documentation Approval: Obtain approval from the Claims Lead on eligibility documentation noting time-off exceeding twelve (12) weeks before submitting a claim reimbursement request.
• Claim Submission and Tracking: Record and submit reimbursement requests to the appropriate carrier within authorized dollar authority, tracking and following up on outstanding payments.
• Reimbursement Issuance: Review and issue reimbursements, notifying designated contacts accurately and in a timely manner.
• Claim Tracking Logs: Maintain internal claim tracking logs to ensure accurate records.
• Year-End Account Closure: Manage the settlement of all reimbursement requests at the end of the plan year to properly close the client’s account.
• Adaptability and Team Collaboration: Handle other duties and projects as assigned, showcasing adaptability and strong collaboration skills.

Qualifications

• Education and Experience: A college degree or equivalent work experience is strongly preferred.
• Tech Proficiency: Proficiency with Microsoft Office products (Word, Excel, Outlook, and Teams) is preferred.
• Critical Thinking: The ability to critically think and problem-solve.
• Confidentiality: Ability to maintain strict confidentiality.
• Organizational Skills: Ability to multitask, adjust to changing priorities, and effectively manage time to meet deadlines.
• Communication Skills: Effective written and verbal communication skills with both internal and external parties.
• Attention to Detail and Urgency: A sense of urgency and attention to detail are necessities.
• Eager to Learn: Eagerness to learn Stealth’s business model is a necessity.

Benefits

• Flexibility: Enjoy a hybrid work environment with flexible scheduling options.
• Comprehensive Benefits: Access a competitive benefits package from day one, including generous Paid Time Off (PTO) and paid holidays.
• Continual Learning: Thrive in a collaborative, education-focused work environment.
• Anual Bonus Program: Earn incentives through our performance-based bonus program, designed to reward you for achieving key goals and contributing to the company's success.