Career Opportunities

– Ability to read, understand, and communicate medical benefits according to SPD language;

– Process medical, dental, or visions claims while providing customer service via inbound/outbound phone calls and written communications;

– Respond to inquiries and phone calls from providers, policyholders, and agents regarding benefits, coverage, or claims status in accordance with established performance expectations;

– Prompt and timely processing of claims accurately according to established expectations (150 claims per day);

– Process claims in accordance with benefit contracts, plan policies, and production/quality requirements;

– Prior to claim adjudication, establish proof of loss by reviewing and understanding medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims;

– Maintain quality customer services through call center; follow customer service practices; adhere to timely expectations according to established expectations (50 calls per day);

– Request and follow-up on additional information as needed for incomplete claims, to include but not limited to COB, accident investigations, eligibility, etc.;

– Familiar with and understands various fee schedules;

– May include but are not limited to: processing claims, claim system testing, over/under payments and special projects.