Claims Specialist

The Claims Specialist is responsible for performing complex claim adjudication duties related to Flex administration such as Section 125, 129, 132, 105(h) plans, etc. to maximize quality, quantity and total customer/client satisfaction.

Duties include but are not limited to:

• Process claims in a timely manner.
• Review and perform all claim adjustment requests.
• Research all claim reversal requests to determine approval or denial.
• Debit card disputes – Handle all fraudulent/disputed transaction requests by participants.
• Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues.
• Process manual adverse determination letters to notify participants of need for additional information, or to afford them the right to appeal, per plan rules.
• Adjudicate transactions that fail auto review & make the determination if additional information is required to approve the transaction. Process manual adverse determination letters to notify participants of need for additional information, or to afford them the right to appeal, per plan rules.

Requirements

• High School Diploma or equivalent.
• Knowledge of ERISA guidelines preferred
• Solid oral and written communication skills with strong attention to detail
• Ability to effectively manage multiple priorities utilizing effective organizational and time management practices
• Ability to effectively interact, present information, and respond to questions from customers, colleagues and management
• Self-starter with the ability to work independently in a fast-paced environment with critical deadlines

Benefits:

• Health Insurance (100% fully paid employee coverage)
• Medical Expense Reimbursement Account that covers almost all of your out-of-pocket medical costs
• Dental Insurance (100% fully paid employee coverage)
• Vision Insurance
• Free Downtown Parking or Free Monthly Commuter Pass
• Short Term & Long Term Disability (100% Employer Paid)
• Employer Matching 401(k) Plan
• Casual Dress Environment (We want you to be comfortable, too!)
• And so much more!

Job Type: Full-time

Pay: $16.50 - $18.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• Hybrid work

Application Question(s):

• How many years of claims processing experience do you have?

Ability to Relocate:

• Williamsville, NY 14221: Relocate before starting work (Required)

Work Location: Hybrid remote in Williamsville, NY 14221