Claim Benefit Specialist – Federal FFS Team

Job Description: • Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. • Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. • Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements. • Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims. • Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution. • Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims. • Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies. • Develops and implements regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development. • Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department. Requirements: • 1-2 years’ experience working in Customer Service. • Possess strong teamwork and organizational skills. • Strong and effective communication skills. • Ability to handle multiple assignments competently through use of time management, accurately and efficiently. • Strong proficiency using computers and experience with data entry. • Experience in a production environment preferred. • Healthcare experience preferred. • Claim processing experience preferred but not required. • Understanding of medical terminology. 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 • Many other benefits depending on eligibility. Apply tot his job Apply To this Job