✨ About The Role
- The Senior Claim Benefit Specialist will review and adjudicate complex and sensitive claims according to established guidelines.
- This role involves acting as a subject matter expert, providing training and coaching to junior staff members.
- The specialist will handle customer service inquiries related to pre-approval, reconsiderations, and appeals.
- Compliance with all requirements is crucial, ensuring that payments align with company practices and procedures.
- The position includes distributing daily work assignments and making outbound calls to gather necessary information for claims.
âš¡ 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, indicating the ability to work efficiently under pressure.
- The candidate should possess strong organizational skills to handle multiple assignments competently and accurately.
- A background in self-funding and knowledge of DG systems is preferred, showcasing a deeper understanding of the claims landscape.
- The successful individual will be proactive in identifying discrepancies and reporting irregularities in claims processing.