Adjudication, Analysis Skills, Claims Processing, Contract Analysis, Contract Processing, Detail Oriented, Documentation, Establish Priorities, Identify Issues, Language Interpreter, Maintain Compliance, Medical Records, Medical Terminology, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft Word, Presentation/Verbal Skills, Problem Solving Skills, QoS (Quality of Service), Regulatory Compliance, Request for Information (RFI), Risk Management, Service Level Agreement (SLA), Support Documentation, Team Player, Time Management, Writing Skills
Title: Critical Illness Claims Rep
Duration: 6 months
Location: Minneapolis, MN. (2 days/week) - Contract to Perm for the right candidate.
Hybrid expectations into Minneapolis, MN. (2 days/week). Enjoy the vibrant city life of Minneapolis, known for its cultural landmarks and beautiful parks, while working in a dynamic and supportive environment.
Responsible for interpreting contract language and processing claims with high complexity. Provide a high quality of service with minimal direction, that is consistent with regulatory and compliance requirements.
Description:
- Analyze and determine Critical Illness claim processing in an accurate and timely manner, to include payment, denial, and requests for additional information.
- Create and maintain excellent working relationships and communication with internal and external customers.
- Actively participates in root cause problem-solving activities in a team environment.
- Manage work queue assignments within agreed SLAs, and support others in the same.
- Ability to handle complex claims including communicating with customers by phone and providing empathy and de-escalating measures for sensitive issues.
- Other duties and projects as assigned.
Knowledge & Experience:
- Experience with Voluntary Critical Illness Insurance benefits preferred with complex medical review experience.
- Strong ability to decipher medical terminology and documentation to connect with Policy definitions to determine if all conditions of the benefit are met.
- Interpret diagnoses and clinical evidence within medical records to determine when an individual was diagnosed with their condition(s).
- Reduce risk through attention to detail to maintain compliance guidelines and ensure decisions are fully supported by documentation and policy language.
- Strong written and oral communication capabilities to provide clear, policy-based denial letters to our customers.
- Understand Standards of Work and job aids.
- Advanced technical proficiency with claims processing systems and the ability to navigate multiple systems concurrently to research, validate, and adjudicate claims efficiently.
- Strong working knowledge of Microsoft Office applications (Excel, Word, Outlook).
- Proven critical thinking and problem solving.
- Capacity to prioritize and balance workloads in a workflow environment.
- Ability to collaborate with others, to include across departments, to solution for shared customers.
T
Talent Software Services, Inc.