What are the responsibilities and job description for the CLAIMS SUPPORT SPECIALIST position at HealthSmart?
Our HealthSmart team understands the difference we make when treating our clients, their members, and HealthSmart employees with dignity and respect. We embody our mission by promoting a diverse and inclusive culture while ensuring career flexibility and growth opportunities. Some of what we offer:
- Flexible schedules like remote and hybrid location opportunities for qualifying roles
- Job Discovery Program for employees who are interested in a career path within the organization
- Continued learning for HealthSmart employees including a Leadership Development Program
- Tuition Reimbursement Program
- Employee Referral Bonus Program
- Employee rewards and recognition program
HealthSmart is one of the largest third-party administrators in the country and the premier provider of customizable and scalable health plan solutions for self-funded employers. We have a collaborative and engaged employee culture, ranking in the top 10% of employers across the country. We rank in the top 5% of health care companies in client satisfaction. We are a growing organization full of opportunities for you to advance your career, having filled over 30% of our open positions with internal applicants.
POSITION SUMMARY
At HealthSmart, the Claims Support Specialist enters claim status information into the Electronic Database Interchange to provide exact claim status information to clients, ensuring accuracy and completeness. Additional responsibilities include conducting investigations to determine claim coverage in accordance with benefit plans. Previous experience handling workers compensation claims is beneficial to office operations.
Location
- Remote position
Preferred Skills and Experience
- Electronic Database (EDI) experience
- Microsoft Office (Word, Excel, Outlook)
- Workers’ Compensation claims experience
- Customer service experience
Essential Functions Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
- Handle state appeals and reworks
- Process claims over-payments and under-payments
- Issue refund checks
- Execute payment recovery procedures
- Research claim inquiries
- Follow-up with Insurers and Providers to resolve problems and answer questions
- Operate claims system and reference plan documents to research claim issues
- Demonstrate satisfactory performance levels in relation to production, quality standards, and attendance
- Maintain compliance with Company policies and Procedures
- Provide phone back-up for the Customer Service department
- Communicate with internal and external customers regarding benefit and claim issues
- Administrative functions such as typing, photocopying, faxing, filing, scanning, indexing, and data entry
Physical Requirements
- While performing the duties of this job, the employee is frequently required to sit, talk, and hear
- The employee is occasionally required to walk; use hands and fingers to feel, handle, or operate objects, tools, or controls; and reach with hands and arms
- The employee must occasionally lift and/or move up to 30 pounds.
- Specific vision abilities required by this job include close vision and the ability to adjust focus
- The work is performed in a remote position
- The noise level in the work environment is moderate
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position.
HealthSmart provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.
Salary : $35,500 - $45,000
EVS Specialist/Utility Housekeeper
INTEGRATED SUPPORT SOLUTIONS INC -
Lubbock, TX
Part-Time EVS & FNS Specialist/Housekeeper
INTEGRATED SUPPORT SOLUTIONS INC -
Lubbock, TX
Full-Time EVS & FNS Specialist/Housekeeper
INTEGRATED SUPPORT SOLUTIONS INC -
Lubbock, TX