Benefit Claims Specialist
4 days ago
Overview
At CCMSI, we strive to deliver exceptional service to our clients. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.
Responsibilities
- Interpret plan documents on policy or coverage questions or issues, resolve claims problems, review denials, subrogations or coordination of benefits with assistance from other staff or Medical Reviewer as needed.
- Proper and expeditious handling of medical, dental and prescription drug card claims processing and payment according to the assigned client's Schedule of Benefits and contract provisions.
- Work closely with the client's Plan Administrator or other designated individual(s) to resolve any claim problems related to the account, or provide needed information.
- Answer client questions, including but not limited to claims payment status and coverage information for assigned accounts.
- Answer questions from Benefit Analysts, Senior Benefit Analysts and other members of the team. Serve as a resource for questions or for problem resolution for less experienced team members. Train new team members as requested.
- Upon receipt of claims, review and process, on computerized adjudication system, for payment under the client's Schedule of Benefits and contract.
- Other related duties include contacting client or health care providers for refunds on overpayments or errors on claims processed; entering of pertinent employee information for new accounts; insuring claims are processed within the policy year or run-out period for incurred/paid contracts.
- Following completion of the claims process/payment, all related paperwork to Support Services, unless the claim is a specific or hold claim.
- Performs other duties as assigned.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Excellent oral and written communication skills.
- Initiative to set and achieve performance goals.
- Good analytic and negotiation skills.
- Ability to cope with job pressures in a constantly changing environment.
- Knowledge of all lower level claim position responsibilities.
- Must be detail oriented and a self-starter with strong organizational abilities.
- Ability to coordinate and prioritize required.
- Flexibility, accuracy, initiative and the ability to work with minimum supervision.
- Discretion and confidentiality required.
- Reliable, predictable attendance within client service hours for the performance of this position.
- Responsive to internal and external client needs.
- Ability to clearly communicate verbally and/or in writing both internally and externally.
Education and/or Experience
High school diploma or equivalent.
3+ years claims experience.
Medical terminology required.
Computer Skills
Proficient with Microsoft Office programs.
Certificates, Licenses, Registrations
None required.
CORE VALUES & PRINCIPLES
Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.
CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefit package including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K.
-
Claims Specialist
5 months ago
Metairie, United States Marsh McLennan Companies Full timeDescription: SUMMARY: As a Claims Specialist for the Marsh McLennan Agency, you will be a claims consultant providing oversight and advocacy on behalf of our clients throughout the process of a loss event and the life of a claim. Duties include: You will submit claims or provide guidance on claim submission; Review coverages and resolve claims...
-
Claims Support Specialist
3 weeks ago
Metairie, Louisiana, United States AmWINS Group Full timeJob Title: Claims Support Specialist Job Summary: We are seeking a highly organized and detail-oriented Claims Support Specialist to join our team at AmWINS Group. In this role, you will provide administrative support to staff and customers regarding claims-related inquiries and requests. Key Responsibilities: * Generate various system reports * Ensure...
-
Claims Support Specialist
4 weeks ago
Metairie, United States AmWINS Group Full timeCOMPANY SUMMARY The American Equity Underwriters, Inc. (AEU) (An Amwins company) is the program administrator of the American Longshore Mutual Association, Ltd. (ALMA), a group self-insurance fund authorized by the U.S. Department of Labor to provide USL&H coverage for the liabilities of its members under the United States Longshore & Harbor Workers'...
-
Benefit Claims Processor
3 months ago
Metairie, United States CCMSI Full timeOverview At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development...
-
Construction Liability Claims Specialist
4 weeks ago
Metairie, Louisiana, United States Travelers Insurance Full timeJob Title: Construction Liability Senior Technical SpecialistAt Travelers Insurance, we're committed to delivering exceptional products and services to our customers. As a Construction Liability Senior Technical Specialist, you'll play a critical role in ensuring that our customers receive the best possible claims experience.Key Responsibilities:Investigate...
-
Claims Consultant
4 days ago
Metairie, Louisiana, United States Marsh LLC Full timeClaims Specialist RoleJob Summary: We are seeking a skilled Claims Specialist to join our team at Marsh McLennan Agency. As a Claims Specialist, you will provide expert guidance and advocacy on behalf of our clients throughout the claims process.Key Responsibilities: Submit claims or provide guidance on claim submission;Review coverages and resolve claims...
-
Multi-Line Liability Claim Representative II
2 days ago
Metairie, United States CCMSI Full timeOverview At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs,...
-
Medical Claims Processor
4 weeks ago
Metairie, United States CCMSI Full timeJob Title: Benefit Claims ProcessorAbout the Role:We are seeking a highly skilled Benefit Claims Processor to join our team at CCMSI. As a Benefit Claims Processor, you will be responsible for processing medical, dental, and prescription drug card claims for assigned accounts according to individual client contracts.Key Responsibilities:Interpret plan...
-
Claims Analyst Manager
4 weeks ago
Metairie, United States Armstrong Receivable Management Full time{"h1": "Claims Analyst Manager Job Description", "p": "At Armstrong Receivable Management, we are seeking a skilled Claims Analyst Manager to join our team. As a Claims Analyst Manager, you will be responsible for identifying files with subrogation potential and supervising analysts. Your expertise will help us maximize the identification of claims with...
-
Claims Analyst Manager
3 weeks ago
Metairie, United States Armstrong Receivable Management Full timeJob Title: Claims Analyst ManagerArmstrong Receivable Management is seeking a skilled Claims Analyst Manager to join our team. As a Claims Analyst Manager, you will be responsible for identifying files with subrogation potential and supervising analysts.Key Responsibilities:Monitor performance and conduct quality assurance through reject analysis and closed...
-
Construction Defect Technical Specialist
4 days ago
Metairie, Louisiana, United States Travelers Insurance Full timeJob SummaryWe are seeking a highly skilled Construction Defect Technical Specialist to join our team at Travelers Insurance. As a key member of our claims team, you will be responsible for investigating, evaluating, and resolving complex construction defect claims.Key ResponsibilitiesInvestigate and evaluate construction defect claims to determine liability...
-
Claims Adjuster, Workers' Compensation
3 weeks ago
Metairie, United States CCMSI Full timeOverview:If the following job requirements and experience match your skills, please ensure you apply promptly.At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an...
-
Medical Billing Specialist
2 weeks ago
Metairie, United States GULF SOUTH FOOT AND ANKLE Full timeJob Title: Medical Billing SpecialistWe are seeking a skilled and detail-oriented individual to join our team as a Medical Billing Specialist at Gulf South Foot & Ankle. As a Medical Billing Specialist, you will play a crucial role in ensuring the efficient processing of medical billing, insurance claims, and patient accounts.Responsibilities:Utilize medical...
-
Medical Billing Specialist
3 weeks ago
Metairie, Louisiana, United States Quipt Home Medical Full timeJob SummaryWe are seeking a highly skilled and detail-oriented Medical Billing Specialist to join our team at Quipt Home Medical. As a key member of our respiratory equipment team, you will be responsible for ensuring timely reimbursement for services provided.Key ResponsibilitiesInitiate billing claims and process denials in a timely mannerVerify payor...
-
Worksite Benefit Specialist
4 days ago
Metairie, Louisiana, United States McDaniel Agency Full timeWork with UsWe are seeking a motivated and enthusiastic individual to join our team as a Worksite Benefit Specialist. As a key member of our team, you will be responsible for meeting with business owners and HR personnel to offer and maintain employee benefit plans through payroll deduction.Key ResponsibilitiesEstablish and maintain relationships with...
-
Worksite Benefit Specialist
4 days ago
Metairie, United States McDaniel Agency Full timeJob OpportunityWe are seeking a skilled and motivated individual to join our team as a Worksite Benefit Specialist. As a key member of our team, you will be responsible for building relationships with clients and ensuring financial protection for them and their families.Key ResponsibilitiesEstablish and maintain relationships with business owners, HR...
-
Employee Benefits Solutions Specialist
3 days ago
Metairie, Louisiana, United States World Insurance Associates, LLC. Full timeJob OverviewAt World Insurance Associates, we're seeking a skilled Employee Benefits Solutions Specialist to join our team. As a key member of our Employee Benefits team, you'll play a crucial role in helping clients build a capital-efficient and employee-centric program designed to mitigate their unique exposures.Key Responsibilities:Identify and solicit...
-
Benefits Specialist
3 weeks ago
Metairie, Louisiana, United States Globe Life AIL - Will Warner Full timeUnlock Your Potential as a Benefits RepresentativeAt Globe Life Liberty National, we're dedicated to helping families safeguard their assets and secure their futures. As a Benefits Representative, you'll play a pivotal role in delivering exceptional customer service and embodying our values of ambition, respect, and high-energy teamwork.Key...
-
Metairie, United States McGriff Insurance Services Full timeThe position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one. If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to Accessibility (accommodation requests only;...
-
Metairie, United States TIH Insurance Full timeThe position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one. If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to Accessibility (accommodation requests only;...