Claims Support Specialist

1 week ago


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

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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