Claim Benefit Specialist

Job Description: • Performs claim documentation review, verifies policy coverage, assesses claim validity, and ensures accurate and timely claims processing. • Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. • Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. • Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements. • Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims. • Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution. • Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims. • Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department. Requirements: • 1-2 years’ experience working in Customer Service • Strong teamwork and organizational skills • Strong and effective communication skills • Ability to handle multiple assignments competently through use of time management, accurately and efficiently. • Strong proficiency using computers and experience with data entry • Experience in a production environment (preferred) • Healthcare experience (preferred) • Understanding of medical terminology Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs including wellness screenings, tobacco cessation and weight management programs • Confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access Apply tot his job