Specialty Claims Processor / CSR Formula Corporation Eagan, MN Job Details Full-time From $60,000 a year 1 day ago Benefits Internet reimbursement Health savings account Paid holidays Health insurance Dental insurance 401(k) Flexible spending account Paid time off 401(k) 5% Match 401(k) matching Life insurance Retirement plan Qualifications Customer communication Confidential information handling Regulatory compliance in claims processing HR legal compliance Attention to detail Document review Business Administration Productivity software Business Associate's degree Customer service problem-solving Documentation reviews Time management Full Job Description Job Summary We are seeking a detail-oriented and experienced Claims Processor and Customer Service Representative to join our team. The ideal candidate will manage and process claims, verify eligibility and coverage, and work with participants, healthcare providers, and insurance carriers to resolve claim-related issues. This role will also assist with FMLA administration, maintain accurate and confidential records, and ensure claims and leave requests are handled timely and in compliance with applicable policies and regulations.

Key Responsibilities:

Process and manage claims in accordance with company policies and procedures. Investigate claims, verify eligibility and benefits, and determine approval or denial. Communicate with participants, healthcare providers, and insurance carriers to resolve claim issues and provide status updates. Maintain accurate claim records, documentation, and payment information, including check processing. Manage assigned caseload and ensure claims are processed accurately and timely. Review plan documents and provide feedback to plan administrators. Identify and report claim discrepancies or processing concerns. Administer FMLA leave requests, including eligibility, medical certification, approvals/denials, and required communications. Maintain confidential FMLA records and conduct periodic audits for compliance. Review monthly reports, maintain/archive records, and stay current on applicable regulations and policies. Provide backup support for COBRA administration and assist with other duties as needed.

Qualifications We Require:

Associate's degree in business administration, healthcare administration, human resources, insurance, or a related field, or an equivalent combination of education and relevant work experience. 2-3 years of experience in claims processing, insurance, benefits administration, healthcare, or a related field preferred. Knowledge of benefitsand coverage determination. Experience with FMLA, leave administration, and/or COBRA preferred. Strong attention to detail with the ability to review and maintain accurate documentation. Excellent written and verbal communication and customer service skills. Strong organizational and time-management skills with the ability to manage multiple claims and priorities. Ability to interpret plan documents, policies, and applicable regulations. Ability to handle confidential and sensitive information with professionalism. Strong problem-solving and decision-making skills. Proficiency with Microsoft Office and the ability to learn claims and benefits administration systems. Ability to work independently while collaborating effectively with participants, providers, insurance carriers, and internal teams.

WHAT WE OFFER

Formula Benefits offers a competitive wage based on experience and a variety of benefits, including competitive salary based on experience, health and dental insurance, life insurance, disability, personal time off, paid holidays, , and a retirement plan with company match. Our work week consists of 37.5 hours instead of 40 hours.

WHO WE ARE

Formula Benefits has been providing quality benefits administration services since 1985. We partner with employers to deliver flexible, cost-effective benefit administration solutions, including self-funded dental benefits, Health Reimbursement Arrangements (HRAs), Flexible Spending Accounts (FSAs), Short-Term Disability, and FMLA/absence management. Our team is committed to providing accurate, timely, and dependable service while making benefits administration easier for employers and their employees. Formula Benefits is an Equal Opportunity Employer.

Pay:

From $60,000.00 per year

Benefits:

401(k) 401(k) 5% Match 401(k) matching Dental insurance Health insurance Health savings account Internet reimbursement Life insurance Paid time off Retirement plan

Work Location:

In person