Trades Medical Benefit Specialist

About the role

The Medical Claims Specialist at Valeris is responsible for assisting provider offices with medical benefit copay programs. This includes handling inquiries, troubleshooting issues, investigating claim statuses, and confirming payment receipts. Additionally, this role involves working with external vendors to address provider medical claim escalations.

Responsibilities

• Manages day-to-day activities and escalations of multiple medical benefit copay programs as assigned
• Aids all stakeholders by providing detailed information for various medical claim situations
• Serves as the focal point for provider medical claim escalations
• Outreach, verbal and written, to provider sites, patients, and other stakeholders associated with supported programs
• Delivers unparalleled customer service while serving as a service representative
• Supports pharmaceutical reps with their sites as needed
• Investigates scenarios and determines resolutions for medical claim situations
• Maintains high levels of ethical conduct regarding confidentiality and privacy
• Maintains records in compliance with applicable standards and regulations
• Evaluates programs/promotions to recommend the development of new tools, forms, and procedures
• Participates in program team meetings and improvement/enhancement initiatives
• Collaborates with external vendors and internal stakeholders to document, escalate, and resolve issues
• Participates in continuing education activities to stay knowledgeable in all programs/promotions and related areas

Qualifications

• Average or Bachelor’s degree preferred; or a minimum of 5 years of customer service/medical claim experience
• Strong understanding of medical claims processing, rejection troubleshooting, reversals / adjustments, and provider medical claims workflows (a plus)
• Ability to provide exceptionally articulate verbal and written communication
• Proficient with Microsoft products including MS Excel skills with the ability to review data sets to conclude outcomes
• Directly supporting and liaising between the client facing teams and technology & operational delivery teams
• Ability to manage and prioritize workload based on competing demands
• Experience managing vendors, contractors, sub-contractors
• Proven problem-solving abilities and strong organizational skills to successfully manage various types of escalations
• Logical and efficient with attention to detail and committed follow through in communication with all stakeholders
• Willingness to work in a dynamic, fast-paced environment and have the ability to multi-task with multiple escalations
• Strong interpersonal skills, ability to work both independently and as part of a team