Specialty Claims Analyst - Troy - BeneSys

    BeneSys
    BeneSys Troy

    1 week ago

    Description
    Specialty Claims Analyst (Troy, MI)
    Summary - The Specialty Claims Analyst will process Disability, SUB, Flex, and Death claims. Provide support for WEX health card users and receive documentation from members through e-mail, fax or by hard copy mail to correctly process submitted claims. Assists with customer service.
    Applicants for this remote role will only be considered if they live in these locations: Illinois, Indiana, Iowa, Kentucky, Michigan, Missouri, Ohio, Pennsylvania, Wisconsin.
    Essential Duties and Responsibilities include but not limited to
    • Process Flex claims in the appropriate amount of time to ensure that member receives payment in a timely manner according to the rules of the plan.
    • Coordinate with Eligibility by informing them of payouts of SUB and Disability benefits to update disability credit hours.
    • Work with the Local Halls to determine benefits for weekly SUB payments.
    • Prepare and send Disability and SUB Reports to the Local Halls on a weekly basis.
    • Determine benefits for multiple groups to process claims correctly, and retrieve documentation required by each group for payments to go out; outcome is either the issuing of a check or sending letters of rejection with proper appeal procedures.
    • Work with Pension to coordinate retirement dates, to avoid overlapping payments of both Pension and Disability simultaneously.
    • Document Disability and SUB dates to avoid overpayments; request refunds from members when overpayments are made.
    • Run checks on assigned days weekly, for SUB, Disability, Flex and Death Benefits, advise Operations of these check runs, and coordinate with accounting on the release of checks.
    • Process stops payments, voids and refunds for all benefit types.
    • Provide back-up for Customer Service and Eligibility; take calls in assigned queue for SUB, Disability, Flex and Death Claims.
    • Research payments according to plan rules to respond to members requests for payment of claim; call back members with result. Ensure the member that claim was processed correctly, and the maximum benefit was received.
    • Process death applications and gather information needed for different life insurance carriers for processing of death benefits.
    • Maintain claims processing quality standards of at least 98%.
    • Maintain claims turnaround times as defined by Specialty Claims Management based on type of claim assigned (claim TAT varies based on SUB, MRA, disability or death)
    • Support Plan Manager/Associates as needed.
    • Regular and predictable attendance is an essential function of this job.
    Qualifications - Individual must be skilled in medical claims processing and knowledge of medical terminology. Have two (2) years of experience in a related field, required. Good reasoning and phone skills. Proficient in Microsoft office.
    Applicants for this remote role will only be considered if they live in these locations: Illinois, Indiana, Iowa, Kentucky, Michigan, Missouri, Ohio, Pennsylvania, Wisconsin.
    Education and/or Experience - High School diploma or GED equivalent. Prior claims experience
    preferred.
    Language Skills - Ability to read and interpret the plan rules as outlined in the SPD (Summary Plan Description), user manuals and department rules & procedures. Ability to communicate with members, union officials and co-workers the plan rules and procedures to process & issue Disability and SUB payments.
    Mathematical Skills - Ability to calculate hours and SUB Credits to properly process claims for payment. Ability to determine tax amounts on payments.
    Reasoning Ability - Ability to calculate and determine eligibility & benefits available according to multiple plan rules to process claims for payment.
    Work Schedule - Full time. Monday - Friday, 7:30am - 4:30 pm. Permanent Remote position (No in-office days).
    Competitive Benefits and Compensation Package
    • 12 paid holidays
    • Paid Time Off (PTO)
      • Pro-rated during first year of employment
      • 15 days of PTO provided in the next calendar year
    • 3 days paid bereavement
    • Up to 20 days paid jury leave
    • Medical, dental, and vision insurance, with option for dependent coverage
    • Company-paid basic life, short-term disability, long-term disability, and AD&D insurance
    • 401k with employer match
    • Tuition reimbursement program
    • Career development opportunities
    • Referral bonus for all successful full-time referrals
    • Annual opportunities for increases
    Pay
    The pay range for this position is $ $24.00 an hour. Actual salary is dependent on skills, experience, education, and other business factors.
    Our Culture
    BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees' successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential.
    Our culture focuses on three core values:
    • Collaboration: working together across 31 locations to achieve the best for the company and our clients
    • Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues
    • Integrity: doing what we say we will do. Upholding strong ethical and moral principles
    ADA & EEO

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