Claims Integrity Specialist

    • Job Tracking ID: 512935-585986
    • Job Location: Meridian, ID
    • Job Level: Entry Level (less than 2 years)
    • Level of Education: Any
    • Job Type: Full-Time/Regular
    • Date Updated: August 04, 2017
    • Years of Experience: Up to 2 Years
    • Starting Date: August 28, 2017
    • Salary Type:: Hourly
    • Rate:: $15.23
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Job Description:

The Claims Integrity Specialist will oversee the large-claim inventory from receipt to check print. This position uses the Decision Tree on a regular basis to administer outcomes using a collaborative approach to ensure that large claims are processed and paid within 30 days or TAT guidelines associated by client and/or network. Ensures large-claims payments are accurate and supported by the plan document, and handles escalated high-dollar claims issues internally with various departments.

Key Result Areas

Essential/Daily

  • Act as a Liaison between AmeriBen’s internal teams to coordinate large-claim processing and payments

  • Monitor claims inventory assigned groups and queues for review of high-dollar claims

  • Monitor escalated large-claims issues with the appropriate departments

  • Monitor the TAT of the claims within the scope to ensure metrics are met

  • Works collaboratively with all internal departments to accomplish common goals

Additional

  • Review and release claims holding for CES review

  • Review and release claims paying under 10K for stoploss

  • Review and release high-dollar claim denials

Experience and Skills:

  • One year experience in the self-funded industry including claims and/or customer service work

  • Complete projects and tasks in a timely and accurate manner

  • Good organizational skills and follow-up skills

  • Good interpersonal, communication and customer service skills both internal and external

  • Proficient in Excel, ability to create worksheets

  • Good problem solving and analytical skills and the ability to prioritize workload

  • Accuracy with numbers

  • Ability to work efficiently and independently, perform multi-tasking, task prioritization and meet tight deadlines

  • Ability to efficiently and effectively perform the Essential Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self

  • Attention to detail

  • Protect and enhance the Core Purpose and the Core Values of the AmeriBen/IEC Group