Senior Claim Benefit Specialist

Reviews and adjudicates medical claims, that may be complex, sensitive, and/or specialized claims in accordance with plan processing guidelines

• 2+ years medical claim processing and experience in production environment
• Experience with Rev coding, CPT / ICD 10 coding
• Experience in managing multiple daily tasks with accuracy and efficiency
• Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise
• Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process
• Ensures 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
• Makes outbound calls to obtain required information for claim or reconsideration

• 2+ years medical claim processing and experience in production environment
• Experience with Rev coding, CPT and ICD 10 coding
• Experience in managing multiple daily tasks with accuracy and efficiency

• 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