Operations Support Specialist managing DHHS ticketing system for compliance. Overseeing internal monitoring and resolution of ServiceNow tickets as a key liaison for internal experts.
About the role
- Claims Support Specialist providing empathetic service in the Workforce Benefits division. Gathering information for claim adjudication while ensuring excellent customer experience through communication and collaboration.
Responsibilities
- Gather information (via phone, fax, or e-mail) that is necessary for claim adjudication
- Review new claims for eligibility requirements, creates and sends claimant letters, and communicates with claimants, brokers, plan administrators, or physicians to obtain information necessary to triage claims to a Claims Specialist
- Completes requests assigned by Claims Specialist to obtain medical documentation and coordinates payment for records when necessary
- Independently manage worklist and complete tasks within established turn-around time expectations
- Communicate effectively across multiple channels, including phone, e-mail, and letter
- Follow outlined steps in a checklist or workflow with a high degree of accuracy and consistency
- Communicate clearly with outside partners such as physicians’ offices and other vendors
- Accurately summarize large quantities of medical information and data into actionable, usable data summaries
- Make basic claims decisions based on the information available to them and adherence to established workflows
- Participates and contributes to team meetings or special tasks and assignments and brings innovative ideas and a continuous improvement mindset to the department
- Consistently supports and promotes change management and/or departmental/enterprise initiatives within assigned area(s) of responsibility
- Fosters strong partnerships and collaborates with key internal areas, such as Claims, Compliance/Legal, Support Services, Intake/Admin, etc.
Requirements
- Strong communication skills – both written and verbal – including the ability to anticipate and address next questions/root cause
- Ability to communicate effectively in a customer-centric and professional demeanor
- Demonstrated ability to use sound judgement and discretion regarding confidential information
- Process improvement mindset – ability to identify trends and suggest process improvements to deliver an improved level of customer experience
- Willingness to accept coaching, and ability to provide coaching and feedback to peers, teammates, and leaders
Benefits
- Your Benefits Start Day 1
- Prioritization of your health and well-being including Medical, Dental, Vision, and Wellbeing Reimbursement Account that can be used on yourself or your eligible dependents
- Generous paid time off options including: Paid Time Off, Holiday Schedules, and Financial Planning Time Off
- Paid Parental Leave as well as an Adoption Assistance Program
- Competitive 401k savings plan with company match and an additional contribution regardless of participation
Job title
Job type
Experience level
Salary
Degree requirement
No Education Requirement
Location requirements
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