Sr Claims Specialist

FEP Senior Claims Specialist Responsible for accurate and timely handling of claim issues for FEP. Applies and maintains comprehensive knowledge of claims processing and support systems. Provides expertise and shares knowledge to support other team members.

Responsibilities

Research and adjust complex and/or high dollar adjustment requests received from all areas, inclusive of internal and external sources (e.g. other plans, providers, FEP Directors Office); Handle FEP reconsiderations accurately and timely per the FEP benefit manuals and guidelines Meet departmental quality and production requirements.

Respond professionally to external/internal inquiries, as appropriate, while maintaining corporate and departmental standards. Research and analyze complex claims that are paid incorrectly; recover overpaid and underpaid claim dollars and ensure all necessary transactional steps are taken to accurately process claim adjustments.

Follow departmental standard for responses to all inquiries, and ensure the standard is achieved. Report observed trends of continuous claim errors/problems for corrective interventions. Assist junior staff as needed.

Qualifications

Education

• High School graduate or equivalent work experience. Experience
• 3 – 5 proven work experience in a production environment. Knowledge, Skills, Abilities Demonstrated math and comprehension skills required. Good interpersonal skills for handling internal and external customers. Well-developed listening, verbal and written communication skills. Proficiency with Microsoft Office, specifically Excel and Word is required. Ability to research and investigate information using multiple sources, operating systems and documented guidelines. Knowledge of claims processing systems (membership, provider, adjustments) Experience working with providers and members preferred Ability to accurately perform research analysis, determine root cause and determine appropriate action Must have strong organizational skills and problem-solving ability. Must be detail-oriented IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.