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Experienced Claims Resolution Specialist
2 months ago
About Us: At MultiPlan, we pride ourselves on fostering a workplace that promotes creativity, innovation, and inspiration. Our dedicated team members play a crucial role in assisting healthcare payers in managing care costs, enhancing competitiveness, and driving positive transformations in the industry.
Our Commitment: We are deeply committed to diversity, inclusion, and belonging, which are integral to our company culture. We strive to cultivate an environment that encourages mutual respect and collaboration, enabling every talented individual to excel in their roles.
Position Overview: The Senior Customer Service Specialist is tasked with managing, researching, and communicating complex and escalated claims inquiries from various stakeholders, including patients, clients, providers, and internal teams. This role also involves coaching and mentoring less experienced team members.
Key Responsibilities:
1. Conduct thorough investigations and analyses to resolve intricate claims inquiries stemming from issues related to discounts, payments, and balance billing, including legal inquiries or complaints.
2. Deliver resolutions and closure to relevant parties, utilizing various communication formats such as emails and formal letters, while initiating follow-up calls as necessary.
3. Adhere to client turnaround requirements regarding response times and necessary actions.
4. Maintain comprehensive documentation of all interactions with clients and providers, ensuring accessibility within relevant systems.
5. Uphold departmental standards for production, accuracy, and turnaround times.
6. Execute system claim adjustments based on findings and communicate confirmations to clients.
7. Address escalated claims and inquiries from team members, providing backup support as needed.
8. Mentor and coach junior team members on effective claims handling and resource utilization.
9. Participate in call center responsibilities, ensuring compliance with established standards.
10. Assist in onboarding new team members and provide constructive feedback to leadership.
11. Undertake various research projects for senior management and clients as assigned.
12. Collaborate and communicate effectively across departments and disciplines.
13. Ensure compliance with HIPAA regulations and requirements.
14. Demonstrate the company's core competencies and values in all interactions.
15. Please note that due to the handling of sensitive data, this role is classified as high risk.
16. The responsibilities outlined above are not exhaustive and may be adjusted as necessary.
Job Scope:
The incumbent operates with minimal supervision, applying a fundamental understanding of principles and practices related to inquiry servicing and resolution follow-up. The role involves complex tasks requiring independent judgment within established guidelines, with the option to seek management guidance when necessary. Regular interaction with both external and internal customers is expected, and the individual may serve as a primary contact for priority clients. While this position does not involve direct supervision, the incumbent will act as a resource for the team and may provide input on training recommendations.
