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Claims/Cust Care Spec II-TPA
4 months ago
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
· 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.
