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Claims/Cust Care Spec

1 month ago

Cleveland, United States Medical Mutual Full time
The Claims/Customer Care Specialist - TPA position allows you the flexibility to work at home as long as you reside within a 50-mile radius of the Brooklyn, Ohio Medical Mutual office.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans.

Medical Mutual' s status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us and help our members achieve their best possible health and quality of life.

Applies knowledge and skills obtained through on the job training to process routine healthcare claims and respond to inquiries from third party administration and/or ancillary product services customers regarding benefits, coverage or claim status, in accordance with established performance expectations and service philosophy.

Responsibilities

Claims/Customer Care Specialist I - TPA

•Processes routine healthcare claims while providing customer service via inbound/outbound phone calls and written communications.

•Assists with projects as directed by management.

•Performs other duties as assigned.

Claims/Customer Care Specialist II - TPA

•Processes routine to moderately complex healthcare claims and/or adjustments while providing customer service via inbound/outbound phone calls and written communications.

•Under direction of more senior staff, conducts routine claims research in response to inter/intra-departmental inquiries.

•Assists with projects as directed by management.

•Performs other duties as assigned.

Sr. Claims/Customer Care Specialist - TPA

•Processes routine to complex healthcare claims and/or adjustments while providing customer service via inbound/outbound phone calls and written communications.

•Conducts and responds to complex claims research projects in response to inter/intra-departmental inquiries and escalations.

•Serves as a peer mentor/trainer for team members and initiates and provides input for process improvements.

•Assists with projects as directed by management.

•Performs other duties as assigned. Qualifications

Claims/Customer Care Specialist I - TPA

Education and Experience:

•Associate degree in business administration, Communications or related field or equivalent combination of training and experience.

•1 year customer service and/or claims experience, preferably in a call center in the health insurance industry.

Professional Certification(s):

•Healthcare field certification a plus (e.g., medical terminology, certified coder/biller).

Technical Skills and Knowledge:

•Basic Microsoft Office Skills

•Basic knowledge of health insurance products and medical terminology.

Claims/Customer Care Specialist II - TPA

Education and Experience:

•Associate degree in business administration, Communications or related field or equivalent combination of training and experience.

•2 years' experience as a Claims/Customer Care Specialist or equivalent customer service experience in the health insurance industry. Third Party Administration experience a plus.

Professional Certification(s):

•Healthcare field certification a plus (e.g., medical terminology, certified coder/biller).

Technical Skills and Knowledge:

•Basic MS Office skills

•Thorough knowledge of third party administration/ancillary products, services, policies, procedures and systems.

Sr. Claims/Customer Care Specialist - TPA

Education and Experience:

•Bachelor's degree in business administration, Communications or related field preferred, but will consider collective experience, training and education.

•3 years' experience as a Claims/Customer Care Specialist or equivalent customer service experience in the health insurance industry. Third Party Administration experience a plus.

Professional Certification(s):

•Healthcare field certification a plus (e.g. medical terminology, certified coder/biller).

Technical Skills and Knowledge:

•Basic MS Office skills

•Thorough knowledge of third party administration/ancillary products, services, policies, procedures and systems.

Medical Mutual is looking to grow our team We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:
  • We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
  • Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
  • On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
  • Discounts at many places in and around town, just for being a Medical Mutual team member.
  • The opportunity to earn cash rewards for shopping with our customers.
  • Business casual attire, including jeans.
Excellent Benefits and Compensation:
  • Employee bonus program.
  • 401(k) with company match up to 4% and an additional company contribution.
  • Health Savings Account with a company matching contribution.
  • Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
  • Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
  • Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
  • After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.
An Investment in You:
  • Career development programs and classes.
  • Mentoring and coaching to help you advance in your career.
  • Tuition reimbursement up to $5,250 per year, the IRS maximum.
  • Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.