Claim Benefit Specialist

Role Overview

• Performs claim documentation review, verifies policy coverage, assesses claim validity, and ensures accurate and timely claims processing
• Handles and processes benefits claims submitted by healthcare providers and members, ensuring accuracy, efficiency, and strict adherence to policies and guidelines
• Determines the eligibility and coverage of benefits for each claim based on the member’s insurance plan and policy guidelines
• Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements
• Documents claim information in the company system
• Conducts reviews and investigations of claims that require additional scrutiny or validation

Requirements

• Possess strong teamwork skills
• Ability to work independently and manage multiple priorities
• Excellent analytical, organizational, and communication skills
• Strong proficiency using computers, experience with data entry
• Able to identify service problems and initiate appropriate actions for quick resolutions
• A commitment to excellence and a work ethic that demonstrates our dedication to our customers

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility