Benefit Claims Processor

Overview

At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients.

As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts.

Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.

Reasons you should consider a career with CCMSI :

• Culture : Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.
• Career development : CCMSI offers robust internships and internal training programs for advancement within our organization.
• Benefits : Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
• Work Environment : We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.

The Benefit Analyst position is an in-office role, operating Monday through Friday from 8 am to 4 : 30 pm, on an hourly basis.

This role involves the processing of medical bills for the health fund, requiring familiarity with medical and dental insurance, the ability to interpret and understand plan documents and summary plan designs, and a basic knowledge of ICD-10, CPT, and HCPCS codes.

Excellent oral and written communication skills and proficiency in Microsoft Office are essential.

The Benefit Analyst is responsible for processing medical, dental, and prescription drug card claims for assigned accounts according to individual client contracts.

This includes handling subrogation, processing weekly indemnity claims (STD), checking and releasing hold claims, performing claim audits for the claims team, working with outside auditors and / or excess carriers on audits, and handling MSPs.

The role also involves greeting and providing client service to on-site visitors, acting as a resource for less experienced staff, and troubleshooting problems or issues that arise in the claims area.

Medical terminology knowledge is required.

Responsibilities

• Interprets plan documents on policy or coverage questions or issues, resolves claims problems, review denials, subrogations or coordination of benefits with assistance from other staff or Medical Reviewer as needed.
• Proper and expeditious handling of medical, dental and prescription drug card claims processing and payment according to the assigned client’s Schedule of Benefits and contract provisions.
• Work closely with the client’s Plan Administrator or other designated individual(s) to resolve any claim problems related to the account, or provide needed information.
• Answer client questions, including but not limited to claims payment status and coverage information for assigned accounts.
• Answer questions from Benefit Analysts, Senior Benefit Analysts and other members of the team. Serve as a resource for questions or for problem resolution for less experienced team members.

Train new team members as requested.

• Upon receipt of claims, review and process, on computerized adjudication system, for payment under the client’s Schedule of Benefits and contract.
• Other related duties include contacting client or health care providers for refunds on overpayments or errors on claims processed;

entering of pertinent employee information for new accounts; insuring claims are processed within the policy year or run-out period for incurred / paid contracts.

• Following completion of the claims process / payment, all related paperwork to Support Services, unless the claim is a specific or hold claim.
• Performs other duties as assigned.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and / or abilities required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Excellent oral and written communication skills.
• Initiative to set and achieve performance goals.
• Good analytic and negotiation skills.
• Ability to cope with job pressures in a constantly changing environment.
• Knowledge of all lower level claim position responsibilities.
• Must be detail oriented and a self-starter with strong organizational abilities.
• Ability to coordinate and prioritize required.
• Flexibility, accuracy, initiative and the ability to work with minimum supervision.
• Discretion and confidentiality required.
• Reliable, predictable attendance within client service hours for the performance of this position.
• Responsive to internal and external client needs.
• Ability to clearly communicate verbally and / or in writing both internally and externally.

Education and / or Experience

High school diploma or equivalent.

3+ years claims experience.

Medical terminology required.

Computer Skills

Proficient with Microsoft Office programs.

Certificates, Licenses, Registrations

None required.

CORE VALUES & PRINCIPLES

• Responsible for upholding the CCMSI Core Values & Principles which include : performing with integrity; passionately focus on client service;
• embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity;
• insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person;
• maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better;

and leading by example.

CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefit package including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K.

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