BPO Claim Administrative Specialist
Allied Benefit Systems, LLC, United States
Job Description
Job Title: BPO Claim Administrative Specialist
Department: BPO Account Management/Client Service
Reports To: BPO Product Operations Manager
Positions Supervised: N/A
FLSA Status: Exempt
Job Class: 6
Work Schedule: Regular business hours
Assessments: PI Behavioral and Cognitive assessments
POSITION SUMMARY
To execute BPO Claim review and investigation of multiple claim functions, including but not limited to the management and facilitation of High Dollar claim reviews, Stop Loss review for Large Group plans, Case Management processes, claim processing and special claim requests.
ESSENTIAL FUNCTIONS
- Facilitate the High Dollar Claim review process by acting as the primary contact for internal and external claim teams, clients and vendors. Owns audit processes for the High Dollar Claim process for claims $20K to $30K
- Facilitates the CHS claim processes by acting as the primary contact for internal and external claim teams. This includes the Core Value claim processes coordinated through CHS.
- Executes effective resolutions on claim issues and ensures that the appropriate Allied teams are informed, handles claim escalations and sees through to completion.
- Owns Case Management functions through collaboration with AHH and our internal departments to ensure proper documentation and claim handling of Case Management claims scenarios. Processes fee claims for Case Management, Enhanced Case Management and HRA Pharmacy claims.
- Demonstrates strength and understanding of all workflows and business processes to execute the overall service strategy for BPO Clients.
- Fosters a sense of urgency and commitment to achieve goals resulting in the ability to influence the organization to meet and exceed customer expectations.
- Will own responsibility for and facilitate communications as stated above, handle escalations and oversee assist in various ad hoc projects as assigned.
POSITION QUALIFICATIONS
Communication Communicates effectively both internally and externally, where applicable. Includes both written and verbal communication.
Customer Focused Works well with customers/clients both internal and external, promotes a positive image of the company and department, and strives to solve issues raised by customers.
Dependability Meets deadlines, works independently, accountable, maintains focus, punctual, and maintains good attendance record.
Initiative Takes action independently, seeks new opportunities, and strives to see projects to completion.
Interpersonal Skills Builds strong relationships, is flexible/adaptable, works well with others, and solicits feedback.
Job Knowledge Understands the facets of job, aware of duties and responsibilities, and keeps job knowledge current.
Organization Skills Information organized and accessible maintains efficient work space, and manages time well.
Problem Solving Strives to understand contributing factors, works to resolve complex situations.
Productivity Manages workload, works efficiently, and meets goals and objectives.
Self-Development Looks for opportunities to increase knowledge, works to increase responsibility, strives to achieve personal goals and/or maintains licenses and other pertinent requirements.
Sense of Urgency Meets deadlines, establishes appropriate priority, and completes tasks assigned in timely manner.
Teamwork Accountable to team, works to meet established deliverables, appreciates view of team members, and respectful.
Technical Skills Maintains current understanding of technical process/equipment, uses technology to increase performance/productivity; effectively uses online tools and resources.
Requirements
Education
College Degree preferred
Experience
Group Health Insurance/Benefits a plus, but not necessary
SKILLS amp; ABILITIES
MS Word, Excel and Power Point advanced
Internet intermediate
Microsoft Outlook Management- intermediate
Certificates amp; Licenses
N/A
PHYSICAL DEMANDS
None
WORK ENVIRONMENT
The BPO team is a very fast-paced work environment. The employee would work in a group setting collaborating with multiple departments and personalities.