Trades Medical Benefit Specialist

About the Role

The Medical Claims Specialist is responsible for working directly with provider offices utilizing Valeris' medical benefit copay programs that need assistance for a variety of reasons including, but not limited to inquiries on how to submit a medical claim, troubleshoot issues, investigate claim status, or investigate/confirm payment receipt. The Medical Claim Specialist will also work directly with our outside vendors who are responsible for stages of the claim journey to troubleshoot escalations and resolve concerns of the providers.

Responsibilities

• Manages the day-to-day activities and escalations of multiple medical benefit copay programs as assigned
• Assists all stakeholders by acting as an advocate delivering detailed information for various medical claim situations
• Serves as focal point for provider medical claim escalations
• Conduct outreach, verbal and written, to provider sites, patients and other stakeholders associated with supported programs
• Provides unparalleled customer service while serving as a service representative
• Consistently exercises discretion to analyze, interpret, make conclusions and decide what actions to take for each situation
• Support pharmaceutical reps with their sites as needed as it relates to their medical benefit program
• Complete understanding of end-to-end medical claim processes to investigate scenarios and determine a resolution
• Maintains a high level of ethical conduct regarding confidentiality and privacy
• Maintains records in accordance with applicable standards and regulations to the programs/promotions
• Evaluates programs/promotions to recommend the development of new tools, forms, and procedures
• Participates in program team meetings and improvement/enhancement initiatives both current and future
• Collaborates with external vendors and internal stakeholders as needed to properly document, escalate, and resolve issues
• Participates in continuing education activities to remain knowledgeable in all programs/promotions and other related areas

Qualifications

• Associate 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 outcome
• Directly supporting and liaising between the client facing teams and technology & operational delivery teams
• Ability to manage and prioritize workload based on competing demands
• Customer Service – ability to collaborate with users to articulate requests, issues and resolution on time
• 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
• Willing 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

Physical Demands & Work Environment

• While performing the duties of this job, the employee is regularly required to talk or hear
• The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms
• Prefer candidates who can type at least 35 words per minute with 97% accuracy
• Although very minimal, flexibility to travel as needed is preferred
• This job operates in a professional office environment
• This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.

Benefits

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
• Additional health support, including telehealth and Employee Assistance Program (EAP) services
• Company match on Health Savings Account contributions
• Free Basic Life and AD&D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000
• Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
• 401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting
• Paid Time Off (PTO) and Sick Leave to support work-life balance
• Team members receive nine paid holidays plus two floating holidays
• Opportunities for advancement in a company that supports personal and professional growth
• A challenging, stimulating work environment that encourages new ideas
• Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
• A mission-driven, inclusive culture where your work makes a meaningful impact