Claims Support Specialist
1 week ago
The Claims Support Specialist plays a crucial role within the Claims Department, reporting directly to the Claims Department Manager. This position is classified as nonexempt and operates in a dynamic environment.
KEY RESPONSIBILITIES:
The Claims Support Specialist serves as a key advocate for clients throughout the claims process. This role is essential for addressing inquiries and ensuring a seamless claims experience. Responsibilities include:
- Ensuring timely processing of claims and prompt responses to inquiries.
- Providing direct assistance to Agents, Members, Providers, and Broker Services.
- Managing communications through dedicated email and ticketing systems.
- Handling incoming calls on the dedicated claims line.
- Delivering comprehensive assistance and swift resolutions to all inquiries.
- Generating detailed itemizations and processing prior deductible credits.
- Assisting with CMRP claims and related inquiries.
- Validating necessary documentation.
- Processing Explanation of Benefits (EOBs), billing statements, and proof of payments.
- Adjusting claims as necessary and calculating correct coordination of benefits.
- Reviewing and managing claim appeals.
- Utilizing claims management software to verify eligibility and review member accounts.
- Inputting data accurately into the claims management system.
- Demonstrating a thorough understanding of business processes within the organization.
- Performing additional duties as assigned by management.
QUALIFICATIONS:
- A High School Diploma or GED is required; an Associate's or Bachelor's degree is preferred.
- 1-2 years of experience in insurance claims is essential.
- Proficiency in computer applications, particularly Microsoft Outlook, Windows, Excel, and Word.
- Ability to learn and master software utilized in the department.
- Strong time management, organizational, problem-solving, and customer service skills.
- Capability to work effectively under pressure while managing multiple priorities.
- Attention to detail while multitasking is crucial.
WORK ENVIRONMENT:
- Ability to thrive in a fast-paced environment while managing interruptions professionally.
- Capability to work independently with minimal supervision.
- Strong prioritization skills to manage multiple projects simultaneously.
- Excellent problem-solving abilities and meticulous attention to detail.
- Strong written and verbal communication skills, along with interpersonal relationship-building capabilities.
- Ability to handle stressful situations with composure.
- Commitment to maintaining confidentiality and privacy in all aspects of the role.
ESSENTIAL FUNCTIONS:
The following functions are essential to the role, with or without reasonable accommodation:
- Proficiency in reading, writing, and speaking English; knowledge of Spanish is advantageous.
- Basic typing skills are required.
- Ability to adhere to scheduled work hours.
- Physical capability to perform job functions, including bending, stretching, and remaining seated or standing for extended periods.
- Ability to lift and carry small equipment and supplies, weighing up to 20 lbs.
ACCOMMODATIONS:
The organization is committed to providing reasonable accommodations for qualified individuals with disabilities to perform essential job functions, unless such accommodations pose a direct threat or create undue hardship.
EQUAL OPPORTUNITY EMPLOYER:
The organization is an Equal Opportunity Employer, dedicated to the principles of equal employment opportunity. All employment decisions are based on qualifications, abilities, and performance, ensuring a fair and respectful workplace for all individuals.
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