Benefit Claims Specialist

4 weeks ago

Metairie, United States CCMSI Full time
Job Title: Benefit Claims Processor

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.

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