CLAIMS SUPPORT SPECIALIST


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Full Job Description

About HealthSmart

HealthSmart is the premier provider of customizable and scalable health plan solutions for self-funded employers. We reduce costs and improve outcomes, all the while treating our health plan members with dignity and respect. But that’s just the beginning of our story – We make differences in peoples’ lives every single day!

Our HealthSmart team understands the difference we make when treating others with dignity and respect, which is why we embody our mission by promoting a diverse and inclusive culture.

We’re a company of innovators.

We deliver health benefit plans and solutions to provide worry-free, self-funded plan administration, quality coverage, and innovative care.

We provide care management services that change lives and helps employers and members take control of healthcare costs.

HealthSmartRx Solutions delivers extremely attractive pharmacy benefits with an Rx discount program.

Our Network Solutions group offers national, comprehensive provider networks to provide member access to the right care.

HealthSmart Casualty Claims Solutions leverages technology, robust information and unmatched experience to deliver innovative casualty claims management solutions with outstanding results.

We offer business intelligence and web-based reporting. Plus, we offer a variety of health and wellness initiatives and even onsite employer clinics.

POSITION SUMMARY
At HealthSmart, the Claims Support Specialist is responsible for all provider inquiries and making the necessary adjustments.

Essential Skills and Experience

High School Diploma or equivalent
Strong problem identification and resolution skills
Ability to communicate effectively and with diplomacy to Clients, Customers, and all levels of Associates
Ability to prioritize various tasks to meet deadlines
Excellent organization skills and attention to details
Capacity to handle sensitive matters in a secure and confidential manner

Essential Functions Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

Review and respond to written inquiries received from the provider community, as well as inquiries elevated from the call center, pertaining to claim payments, benefit questions, contract questions, member eligibility, claim status, fee schedules, etc.
Communicate response to provider in a professional matter and in accordance with regulatory timeframes.
Promptly escalate to management any inquires that cannot be resolved or that need guidance from the Health Plan.
Adjust claims as needed to provide additional reimbursement or to collect overpaid dollars.
Execute payment recovery procedures.
Demonstrate satisfactory performance levels in relation to production, quality standards, and attendance records.
Maintain compliance with Company policies and Procedures.
Provide phone back-up for the Customer Service department.
Assist claims department as needed with inventory and complex claim issues.

Physical Requirements

While performing the duties of this job, the employee is frequently required to sit, talk, and hear.
The employee is occasionally required to walk; use hands and fingers to feel, handle, or operate objects, tools, or controls; and reach with hands and arms.
The employee must occasionally lift and/or move up to 30 pounds.
Specific vision abilities required by this job include close vision and the ability to adjust focus.
The work is performed primarily in an office setting.
The noise level in the work environment is moderate

The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position

HealthSmart provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

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