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Claims Support Specialist

2 months ago

Ridgeland, Mississippi, United States Morgan White Group Full time
Job Overview

The Claims Support Specialist plays a crucial role within the Claims Department, serving as a key resource for clients throughout the claims process.


PRIMARY RESPONSIBILITIES:

This position acts as a liaison for our clients, ensuring that their inquiries are addressed promptly and effectively. The Claims Support Specialist is dedicated to simplifying the claims experience and gathering valuable feedback to enhance operational efficiency. Daily communication with the Claims Manager and interaction with various stakeholders, including clients and insurance agents, is essential.

  • Ensure timely processing of claims and respond to inquiries within a 24-48 hour timeframe.
  • Assist agents, members, providers, and broker services directly.
  • Manage incoming communications via email and phone.
  • Provide comprehensive support and immediate solutions for all inquiries received.
  • Prepare itemizations, process prior deductible credits, and conduct thorough member audits.
  • Handle CMRP claims and provide necessary assistance.
  • Verify HIPAA compliance and process relevant documentation.
  • Manage billing statements, proof of payments, and claim adjustments.
  • Calculate coordination of benefits (COB) for claims.
  • Review and address claim appeals.
  • Utilize claims management software to verify eligibility and review member accounts.
  • Input data accurately into the claims management system.
  • Maintain a strong understanding of business processes within the organization.
  • Perform additional duties as assigned by management.

QUALIFICATIONS:

  • High School Diploma or GED required; an Associate's or Bachelor's degree is preferred.
  • 1-2 years of experience in insurance claims is necessary.
  • Proficiency in computer applications, particularly Microsoft Outlook, Windows, Excel, and Word.
  • Ability to learn and adapt to departmental software.
  • Strong time management, organizational, problem-solving, and customer service skills.
  • Capability to work under pressure while managing multiple priorities and deadlines.
  • Attention to detail while multitasking is essential.

WORK ENVIRONMENT:

  • Ability to thrive in a fast-paced environment and manage interruptions professionally.
  • Work independently with minimal supervision.
  • Prioritize and manage multiple projects effectively.
  • Exhibit excellent problem-solving skills and attention to detail.
  • Demonstrate strong written and verbal communication skills.
  • Handle stressful situations with composure.
  • Maintain confidentiality and privacy in all aspects of the role.

ESSENTIAL FUNCTIONS:

  • Fluency in English is required; Spanish proficiency is a plus.
  • Basic typing skills are necessary.
  • Adherence to scheduled work hours is expected.
  • Physical ability to perform job functions, including lifting and carrying items up to 20 lbs.

ACCOMMODATIONS:

The organization is committed to providing reasonable accommodations for qualified individuals with disabilities to perform essential job functions.


DIVERSITY AND INCLUSION:

The company is an Equal Opportunity Employer, dedicated to fostering an inclusive environment where all employees are treated fairly and with respect, regardless of their background or characteristics.