Insurance Staff Support Specialist

Responsibilities

• Re-price Contract Health Services/Purchased Referred Care eligible claims to the MLR/PRC for hospital and physicians for both internal and external clients
• Re-price employee health claims in designated PPO software portals
• Assist in the production and distribution of benefit information to members, employees, and clients
• Maintain database of facility CMS Rate Notification letters and submit to data vendor as needed to ensure accurate re-pricing
• Update and maintain Section 506 Recovery reimbursement data via Excel spreadsheets
• Prepare and compile documents for stop-loss and Catastrophic Health Emergency Fund reimbursements
• Update and input pre-certifications and authorizations into claim adjudication
• Identify documents for destruction, maintain destruction schedule, and verify documents are destroyed on-site by document destruction vendor
• Print and distribute daily reports and all letters generated by claims examiners
• Answer incoming customer service calls, manage departmental mail posting, sorting, and distribution
• Assist walk-in customers promptly and courteously
• Assist Accounting Specialist with in-house check runs and create departmental purchasing requisitions for the Director’s approval
• Type letters, reports, memos, and create flyers as requested by supervisor

Requirements

• High school diploma or GED
• Two (2) years of work experience in a medical office, medical facility, health insurance, or employee benefits (preferred)
• Must obtain and maintain HIPAA and Insurance Marketplace CAC certification
• Knowledge of medical terminology and health/medical insurance
• Skill in operating business computers and office machines, including in a Windows environment (Word, Excel, Access, and PowerPoint)
• Ability to communicate effectively and represent the organization in a professional manner
• Must successfully pass all applicable background checks and drug screens

Preferred Qualifications

• Four (4) years of work experience in a medical office, medical facility, health insurance, or employee benefits
• Experience with Indian Health Service

Benefits

• Approximately 5 weeks of paid time off annually
• 3 weeks of paid holidays
• Premium-free health insurance
• Flexible spending accounts
• Short-term disability
• Life insurance
• 401k with match