Claims Resolution Specialist - Free Health Benefit for Entire Family

Free Healthcare for you and your family, what does that mean?

• The average person will spend close to $20,000 a year before health insurance covers the rest of medical treatment
• The cost of healthcare includes monthly premiums, deductibles, co-pays, co-insurance and out of pocket max
• FREE Healthcare means you pay nothing on premiums, nothing for co-pays, nothing for deductibles, and nothing for out of pocket max when you join our team. This is for your entire family! This truly is a FREE healthcare benefit.
• You should not have to worry about the burden of cost when it comes to healthcare for you and your family, we are here to remove that burden.
• If removing the burden of healthcare for your family is important, and helping other people remove that burden is important, then join our team!
• One last note, you can earn even more money than our hourly pay with bonus options, ask our team about it. All you have to do is obsess over helping more people have access to healthcare.

The Claims Resolution Specialist aims to assist the High Dollar Claims team with data entry, tracking and communication related to high dollar claims issues, appeals and assist in facilitating timely resolution.

You made a great choice looking into this role, now make the next right choice in joining a team excited to change the future of healthcare.

LOCATION: Phoenix, AZ

TYPE: Full Time

RESPONSIBILITIES

• Communicates effectively with internal/external stakeholders to obtain needed information for document processing while maintaining a professional demeanor in all interactions.
• Delivers highly routine work and provides general information, in accordance with established procedures and guidelines, in a timely manner and meets deadlines appropriately.
• Enters claims into appropriate databases. Applies foundational knowledge to determine where the claim should be entered and whether the claim should be bridged with an existing claim record.
• Maintains accurate member records by updating appropriate basic data fields to include information necessary for identification of the correct policyholder, policy, account, or claim.
• Meets or exceeds departmental quality and service standards.
• Performs basic task/transactions related to common programs and services by acquiring core knowledge required for the role.
• Provides customer service to internal/external stakeholders, recognizes what needs to be done to meet customer needs and demonstrates flexibility and responsiveness to meet customer needs.
• Recognizes general issues/concerns for assigned area(s) of responsibility, explains effect on the customer's service experience, and suggests process improvements
• Reviews and provides general information to basic questions/concerns from internal/external stakeholders (e.g. internal partners, policyholders, claimants, etc.)
• Reviews basic incoming correspondence to ensure completeness of required data fields including but not limited to name, date of birth, and member ID number.
• Reviews basic incoming electronic/paper correspondence to determine the appropriate work type, indexing and distribution.
• Routes paper correspondence to the proper area or recipient.
• Supports and promotes change management and/or departmental/enterprise initiatives within assigned area(s) of responsibility.
• Carries out duties in compliance with all state and federal regulations and guidelines. Complies with all company and site policies and procedures.
• Makes a positive contribution as demonstrated by: - Making suggestions for improvement - Learning new skills, procedures and processes
• Performs other duties as required.

REQUIREMENTS

• Proficiency in using Microsoft Word, Excel, and an Electronic Medical Record system, Preferred.
• Must be able to successfully pass National Agency Check with Inquiries (NACI) background investigation, Required.
• High School or GED - Minimum Required
  Experience
  1-2 Years of Administrative Support, Customer Service, and/or data entry that directly aligns with the specific responsibilities for this position (Required)
• 1-2 Years of Medical Claims or Appeals experience preferred.

We are transparent in our pay for our Claims Resolution Specialist:

• Starts at $18.00 an Hour
• Free Healthcare for you and your family!

The pay range for this role is:

18 - 21 USD per hour (Phoenix)

Location: Phoenix, AZ, US

Posted Date: 11/21/2024