Senior Claim Benefit Specialist

Job Description: • Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. • Acts as a subject matter expert by providing training, coaching, or responding to complex issues. • May handle customer service inquiries and problems. • Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process. • Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals. • Insures all compliance requirements are satisfied and all payments are made against company practices and procedures. • Identifies and reports possible claim overpayments, underpayments and any other irregularities. • Performs claim rework calculations. • Distributes work assignment daily to junior staff. • Trains and mentors claim benefit specialists. • Makes outbound calls to obtain required information for claim or reconsideration. Requirements: • 18+ months of medical claim processing experience. • Experience in a production environment. • Demonstrated ability to handle multiple assignments competently, accurately and efficiently. • Self-Funding experience (preferred) • DG system knowledge (preferred) 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. • 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. Apply tot his job