JOB TITLE : Claims Specialist (Plan Setup Specialist)
DEPARTMENT : Operations, Plan Setup
LOCATION : Hybrid Mason, OH 45040
PAY RATE : $23-$25 per hour
GENERAL FUNCTION
Serves as a Specialist on the Plan Setup Team responsible for setting up and maintaining client's managed vision care clients in our core administration system.
MAJOR DUTIES AND RESPONSIBILITIES
- Responsible for setting up new Managed Care groups in the claims system
- Fulfill requested revisions to existing Managed Care groups in the claims system (except Reseller product changes)
- Create standard products in the system (using the Product Key Sheet method)
- Perform audits on client setup or maintenance requests (excludes complex product configuration requests)
- Follow corporate and industry audit controls (i.e., SOX, SSAE 18, etc.) when fulfilling setup and maintenance requests
- Resolve client structure setup questions / issues with minimal supervision
- Maintain relationships with Implementation Managers and Account Managers to fulfill implementation questions and requests in a timely manner
- Self-manage completion of work inventory in the Plan Setup production queues within established quality and turnaround time guidelines
- Recommend process and system enhancements to improve team performance
- Support the management team with miscellaneous projects and resolving assigned Plan setup issues
EDUCATION / EXPERIENCE QUALIFICATIONS
- College degree or equivalent experience required
- Minimum of 1 year claims system experience, preferably in the Healthcare industry
- Basic analytical and problem-solving skills
- Good communication and interpersonal skills
- Ability to work independently and collaboratively
- Ability to manage multiple tasks simultaneously
BENEFITS INFO
Russell Tobin offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors.
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