Claims Integrity Specialist I

    • Job Tracking ID: 512935-711756
    • Job Location: Meridian, ID
    • Job Level: Mid Career (2+ years)
    • Level of Education: High School/GED
    • Job Type: Full-Time/Regular
    • Date Updated: November 27, 2019
    • Years of Experience: 2 - 5 Years
    • Starting Date: ASAP
    • Salary Type:: Hourly
    • Rate:: $15.23
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Job Description:

The Claims Integrity Specialist I oversees large claim inventory ensuring benefit payment accuracy on large dollar and Stop Loss claims. This position will use the AmeriBen Decision Tree on a regular basis and ensure large claims are processed and paid within TAT (Turn Around Time) guidelines of the client and/or network, and will verify large claim payments are accurate and supported by the plan document.

 

 

Key Result Areas

 

  • Acts as a liaison between AmeriBen’s internal teams to coordinate large-claim processing and payments.
  • Monitors claims inventory for specific assigned groups.
  • Monitors escalated large-claims issues with the appropriate departments.
  • Monitors the TAT of the claims within the scope to ensure metrics are met.
  • Peforms 15 large-claim reviews per day without risking quality.
  • Works collaboratively with all internal departments to accomplish common goals.
  • Reviews and releases claims holding for CES review.
  • Reviews and releases claims paying under 10K for Stop Loss.
  • Reviews and releases high-dollar claim denials.
  • Performs other duties as assigned or needed.

Experience and Skills:

  • High school degree or equivalent.
  • Two years’ 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.
  • Good problem solving and analytical skills and the ability to prioritize workload.
  • Accuracy with numbers.
  • Team and goal oriented.
  • Must be reliable and flexible.
  • Types 45 wpm, 10-key by touch, and computer knowledge.
  • Able to demonstrate excellent attendance and punctuality.
  • Excellent customer service attitude and professionalism.
  • Demonstrate Accuracy, Customer Service, Timely Turn-Around (ACT).
  • Exceptional verbal and written communication skills.
  • Proficiency using Microsoft Office (Word, Excel, Outlook, etc.).
  • Ability to work efficiently, perform multi-tasking, prioritize tasks, and meet tight deadlines.
  • Possess a high degree of integrity and discretion, as well as the ability to adhere to both company policies and best practices.
  • Ensure compliance with security practices and procedures, including HIPAA and HITRUST standards.
  • Ability to efficiently and effectively perform the Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self.
  • Protect and enhance the Core Purpose and the Core Values of AmeriBen.

 

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.