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Compensation Benefits Specialist
2 months ago
Position Title: Compensation Benefits Specialist
POSITION SUMMARY
The Compensation Benefits Specialist plays a crucial role in managing all facets of benefits configuration, including programming, reviewing, and auditing to ensure precise benefit programming for Authorizations and Claims.
KEY RESPONSIBILITIES
- Utilize Health Plan websites to gather essential benefits information for members.
- Engage with Health Plans via phone to confirm member benefits.
- Verify eligibility concurrently while confirming benefits.
- Collaborate with the Benefits team to establish standards and conduct random audits.
- Document and communicate findings with the Benefits team internally.
- Ensure all systems are responsible, reliable, and responsive to the needs of all IPAs within Advanced Medical Manage.
- Monitor and audit processes and procedures to meet strategic objectives.
- Create and maintain Option Masters for each benefit option provided by the Health Plan by Line of Business, including financial responsibility tables, Out of Pocket Maximums, and Deductibles.
- Develop and implement initiatives to maintain data integrity for benefits configuration and other areas that support effective internal operations.
- Coordinate, document, and develop projects, demonstrating strong organizational skills.
- Assist various departments with inquiries through emails and phone calls, including verifying information with health plans.
- Oversee daily benefits management.
- Input and update benefits for all Health Plans and all IPAs' lines of business.
- Responsible for adding options in EzCap for the Eligibility Department on a daily basis.
- Program, review, and update benefits in EzCap regularly.
- Assist in downloading Benefits Online.
- Generate reports to identify benefit discrepancies.
- Recommend and assist in the development of process improvements, including policies and procedures.
- Support training and development initiatives for the Advanced Medical Manage team.
- Respond to inquiries promptly and provide necessary support.
- Coordinate with various departments to resolve benefits inquiries or system-related issues.
- Exercise sound judgment to plan and achieve goals.
- Perform a variety of tasks as needed.
- Administer and ensure timely completion of all projects.
- Other responsibilities may be assigned as required by leadership.
EDUCATION & EXPERIENCE REQUIREMENTS
- Preferred: College Degree.
- Experience in benefits configuration and interpretation.
- Ability to collaborate effectively with all levels within Advanced Medical Manage.
- Highly organized with the capability to manage multiple tasks efficiently; proficient in computer applications.
- Familiarity with software applications such as EZCAP is advantageous.
- Proficient in Microsoft Office Suite (Word, Excel, Outlook, Access).
- Demonstrated initiative, self-motivation, and a strong work ethic.
- Strong time management skills, with the ability to prioritize multiple project deadlines.
- Produce accurate, high-quality work consistently and punctually.
- Ability to thrive in a fast-paced environment.
- Strong analytical and problem-solving skills are essential.
- Maintain a positive attitude and exhibit excellent communication skills.
- Ability to work independently as well as collaboratively within a team.
This role offers an excellent opportunity for individuals seeking a career transition with significant growth potential in the healthcare sector, contributing to a culture of innovation and success within Advanced Medical Manage.
