Posted in General Business 30+ days ago.
Type: Full-Time
This position is responsible for accurate and timely research of all claim dispute types, timely processing of adjustments and acts as liaison between members, providers and internal claims departments. If a recalculation is warranted and modification to the payment amount is determined to be required, acting within established parameters, this role makes the appropriate payment adjustment into the claims system. Must complete duties with a high level of detailed quality and professionalism.
Responsibilities
Ability to review and interpret contract/account information to successfully resolve issues regarding claim disputes.
Demonstrated ability for problem solving, meeting deadlines, showing initiative and follow-through.
Must be a proficient typist.
Working knowledge of Microsoft Office Product Suite, specifically Excel.
Ability to simultaneously maneuver through various computer claims and eligibility platforms while verifying information while on the telephone.
Excellent verbal and written communication skills.
Must demonstrate professional call handling skills while under stress.
Customer service oriented and a team player.
Must maintain member and provider confidentiality at all times.
Must be flexible in scheduling, be punctual and maintain good attendance.
Understanding of customer service performance metrics (ASA, abandonment rate, talk time).
Comfortable adapting to change.
General Job Information
Title
Claims Resolution Specialist
Grade
20
Work Experience - Required
Claims, Customer Service
Work Experience - Preferred
Bilingual
Education - Required
Education - Preferred
Bachelor's
License and Certifications - Required
License and Certifications - Preferred
Salary Range
Salary Minimum:
$41,505
Salary Maximum:
$62,255
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
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