Claims Integrity Specialist l

Job Description:

15.99 per hour

The Large Claim Inventory Specialist I will oversee large claim inventory verifying benefit payment accuracy on large dollar and stop loss claims. Ensure large claims are processed and paid within guidelines of the client and/or network contracts and benefits applied are supported by the plan document.

Key Functions

• Work with internal teams to ensure plan and/or contract language supports benefits.
• Ability to identify potential global issues that have financial impacts.
• Works collaboratively with all internal departments for claim benefit resolutions.
• Work closely and collaborate with team members to accomplish team goals and metrics.
• Apply critical thinking reasoning through research and documentation that supports the plan benefit.
• Commit to engaging and developing a culture based on humility, hard work, excellence and learning with the team.
• Monitor claims inventory for specific assigned groups.
• Monitor escalated large claims issues with the appropriate departments.
• Monitor TAT of the claims within the scope to ensure metrics are met.
• Minimum 35 claim reviews per day without risking quality.

  AmeriBen is not yet hiring in the below states:

  • Alabama Delaware Massachusetts Mississippi Montana New Hampshire New Jersey New Mexico New York North Dakota Rhode Island South Dakota Vermont

Experience and Skills:

Minimum Qualifications & education

• High school degree, or equivalent
• Proficiency with Microsoft Office products
• Strong problem solving, attention to detail, analytical skills, and the ability to prioritize workload.
• Accuracy with numbers
• Team and goal oriented
• Ability to work efficiently and independently, perform multi-tasking, task prioritization, and meet tight deadlines.
• Strong verbal and written communication skills
• Adherence to Core Purpose and the Core Values of AmeriBen

Preferred Qualification

• Knowledge of medical terminology
• Two years’ experience in the self-funded industry including claims and/or customer service work.

AmeriBen is an Equal Opportunity/Affirmative Action Employer committed to creating an environment of diversity and inclusion for equal employment and advancement opportunities to all employees and applicants for employment. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, national origin, sex, sexual orientation, gender identity and/or expression, genetic information, disability, veteran or military status, or any other category protected by federal, state and/or local law.

• If you are unable to use our online application process due to a disability, please contact the Human Resources Department at humanresources@ameriben.com .