Claims Assessment Specialist II

2 weeks ago


Richfield, Ohio, United States Group Management Services Full time
Group Management Services is seeking a proactive individual to join our team as a Claims Examiner II. This role is pivotal in our operations, ensuring the efficient management of claims from our clients.

As part of our organization, we value a candidate who possesses a strong customer service orientation and a genuine desire to assist others. If you are looking to advance your career in the human resources sector, this position may align perfectly with your aspirations.

Key Responsibilities:
  • Evaluate, process, and adjudicate claims related to medical, dental, and prescription services.
  • Prioritize claims based on urgency and manage workflows within specified timeframes.
  • Address inquiries and ascertain customer requirements, reaching out for additional information when necessary.
  • Support senior claims personnel with audits and internal control measures.
  • Respond to calls and written communications from members, clients, and healthcare providers.
  • Ensure accurate plan implementation for claims processing in accordance with client specifications.
  • Follow up on claims that are pending resolution.
  • Maintain an organized daily workload of processed claims.
  • Investigate all coding review outputs for claims and process them according to established protocols.
  • Review and process claims that have been pending for over 30 days.
  • Resolve outstanding issues on behalf of members by collaborating with relevant departments and providing timely feedback.
  • Initiate necessary adjustments to claims, including ID card replacements and duplicate documentation requests.
  • Participate in vendor meetings, calls, and webinars.
  • Carry out additional duties as assigned.
Qualifications:
  • A High School diploma (or equivalent) is required; a Bachelor's degree is preferred. A minimum of 3 years of relevant experience in medical claims adjudication is essential.
  • Familiarity with CPT and Diagnosis Codes, as well as knowledge of coordinating benefits with primary insurers.
Benefits:
  • Competitive salary range of $58,000-$68,000.
  • Comprehensive benefits package including Medical, Dental, Vision, 401(k) with company matching, Life, and Disability insurance.
  • Tuition reimbursement opportunities.
  • Three weeks of paid time off plus seven paid holidays.
  • Provision of a company laptop or Surface Pro.
  • Monthly reimbursement for mobile phone expenses.
  • Opportunities for professional growth and development.
  • Flexible work schedules promoting autonomy.
Why Choose GMS?

At GMS, we believe that the essence of our business lies in the relationships we cultivate. Since our inception in 1996, we have grown from a small enterprise to a thriving organization with over 500 employees across multiple locations. Our commitment to supporting small businesses is unwavering, and we take pride in fostering meaningful connections that empower our clients to flourish.

As we continue to expand, we are on the lookout for individuals who are dedicated to delivering exceptional service and support. If you share our passion for the small business community and are eager to contribute to their success, we invite you to explore the opportunities available within our team. Join us in building relationships, pursuing growth, and experiencing a workplace culture that values family and collaboration.

For further details, please visit our website.

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