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Claims Concierge Specialist
2 months ago
The Claims Concierge Specialist plays a vital role in ensuring a seamless claims experience for our customers. As a key member of the Claims Department, this individual will be responsible for providing exceptional customer service, resolving claims efficiently, and maintaining accurate records.
Key Responsibilities- Process claims in a timely manner, ensuring a 24-48 hour turnaround on processing and responding to inquiries.
- Assist agents, members, providers, and broker services with claims-related matters.
- Maintain concierge email/faxes and tickets, as well as take direct calls on the concierge phone line.
- Provide in-depth assistance and immediate resolution of all received inquiries.
- Generate itemizations, process prior deductible credits, and provide complete member audits.
- Validate HIPAA forms, process EOBs, billing statements, and proof of payments.
- Process claim adjustments, calculate correct coordination of benefits (COB) claims, and review claim appeals.
- Maintain knowledge of business processes within Morgan White Group and utilize the Policy Administration System and Claims Management Software to verify eligibility and review member accounts.
- High school diploma or GED required; associates or bachelor's degree preferred.
- 1-2 years of previous insurance claims experience.
- Proficiency in computer skills, including Microsoft Outlook, Windows, Excel, and Word.
- Ability to learn and be proficient with software used in the TPA Department.
- Strong time management, organizational, problem-solving, and customer service skills.
- Ability to work well under pressure with multiple priorities and meet deadlines.
The Claims Concierge Specialist will work in a fast-paced environment, requiring the ability to handle interruptions professionally and prioritize projects while maintaining attention to detail.
Essential Requirements- Ability to read, write, and speak English; Spanish is a plus.
- Basic typing skills.
- Ability to work as scheduled.
- Ability to bend, stretch, reach, and sit or stand at a desk during 85% of the workday.
- Ability to lift, stoop, and carry small equipment items and supplies, possibly weighing up to 20lbs.
