In this role you will be helping guide and review team process workflows associated with Conlan reimbursement claims, acting as a subject matter expert or SME for team members, leadership, or the client, support Conlan case processing, and engage in research and member case reviews/escalations.

Role:

Research and process Conlan claims in accordance with established Court Order requirements, applicable policies and procedures, and Service Level Agreement (SLA) standards. Ensure all Member Reimbursement request letters, including incomplete requests, approvals, and denials, are reviewed for completeness, accuracy, and compliance with applicable policies and procedures. Collaborate with team members, management, and customers to address and resolve claim-related issues, ensuring timely communication and effective problem resolution. Assist the Supervisor and senior management with claim research, special projects, and additional assignments as directed, ensuring timely and accurate completion of all tasks. Maintain and update daily, weekly, and monthly reports to ensure accuracy, completeness, and timely reporting of operational performance, workload metrics and adherence to SLA requirements.

Requirements:

High school diploma or G.E.D. Minimum 2 - 3 years of customer service, health care claiming, and/or medical related experience. Experience working with organizational functions and personnel; team lead experience preferred. Ability to follow stringent protocols for policy operations. Experience working with computer software and telephone technology and skilled in the use of help desk software and/or customer relationship management tools. Business and analytical critical thinking skills. Strong communication skills, written and oral; including professional email communications. Ability to take on special projects as needed. Ability to follow oral and written directions. Competency with Microsoft Office Suite and other similar computer programs.

Pay:

$38.00 - $40.71 per hour

Benefits:

401(k) Dental insurance Health savings account Vision insurance Application Question(s): Do you have previous experience processing, reviewing, or researching healthcare or medical claims?

Work Location:

In person