Senior Claim Benefit Specialist - Remote - Remote Eligible

✨ About The Role

- The Senior Claim Benefit Specialist will review and adjudicate complex and sensitive claims in accordance with established processing guidelines. - The role involves acting as a subject matter expert, providing training and coaching to junior staff members. - Responsibilities include applying medical necessity guidelines, determining coverage, and completing eligibility verification for claims. - The specialist will handle phone and written inquiries related to pre-approval, reconsiderations, or appeals. - Compliance with company practices and procedures is crucial, ensuring all payments are made correctly and identifying any irregularities in claims.

⚡ Requirements

- The ideal candidate will have at least 2 years of medical claim processing experience, demonstrating a solid understanding of the claims adjudication process. - Experience in a production environment is essential, showcasing the ability to handle multiple assignments efficiently and accurately. - A strong background in customer service is beneficial, as the role may involve handling inquiries and resolving complex issues. - The candidate should possess excellent communication skills, both written and verbal, to effectively interact with clients and team members. - A high school diploma is required, with a preference for candidates holding an associate's degree or equivalent work experience.