[Hiring] Claims Specialist I @Birdsong Hearing Benefits

Role Description

Advanced Hearing Providers (“AHP”) coordinates hearing healthcare services for employees with workers’ compensation claims. We connect patients with our nationwide network of qualified hearing healthcare providers on behalf of our clients; the payers and third-party administrators of workers’ compensation claims. We are seeking hard-working, self-motivated candidates with a positive attitude who like the idea of being involved in the process of helping people hear better. The position of Claims Specialist (“CS”) I plays a critical role in the operation of the organization. The main function of an AHP CS I is coordinating authorized hearing healthcare for covered employees. AHP staff work as a TEAM – this is crucial! We expect team members to build trust and respect for each other by producing consistent results and going above and beyond, especially to help each other. Even though each CS will be working on their own assigned cases, interaction with other team members, clients, providers, and patients will occur often.

Responsibilities

• Obtain a complete, thorough understanding of the workers’ compensation claims administration process, fees and participants.
• Adhere to customer Service Level Agreements (SLAs) by maintaining contact with clients, providers, and claimants/patients as prescribed to ensure all parties are kept informed of the process status.
• Successfully prioritize the workday utilizing our task-based systems, resulting in achieving daily completion of all required tasks (ensuring SLA compliance).
• Ensure orders are properly documented in a timely manner.
• Demonstrate an understanding of the workers’ compensation referral and RFA process.
• Demonstrate an understanding of navigating client/claimant requirements to ensure billable item eligibility is reviewed prior to submitting requests to client.
• Perform verification of all HCPC/CPT codes that will be requested, including verifying eligibility and confirming whether NCCI edits and/or a state fee schedule (SFS) is applicable.
• Coordinate the completion of necessary documentation to be filed with state agencies when applicable.
• Maintain a high degree of detail and accuracy throughout the claim administration process.
• Cross utilize phone, email, and fax for communication to ensure efficient processing time.
• Assist with phone answering and intake related duties.
• Demonstrate basic to intermediate level process understanding and ability to critically think and solution for complex situations that arise.
• Other duties as assigned by the manager.

Qualifications

• Advanced knowledge and experience with computer systems and business software programs, in particular Salesforce, Word, Excel, Outlook, Office 365 Apps and Adobe Acrobat.
• Previous workers’ compensation, insurance claims management, and/or hearing healthcare industry experience is preferred.
• Bilingual skills will be extremely helpful with some patients.
• Excellent grammar and written skills.
• Ability to type at a minimum of 40 WPM.
• Ability to travel for training and occasional on-site meetings.
• Communicate clearly, professionally and in a timely manner.
• Manage multiple tasks simultaneously in a proficient manner.
• Ability to maintain professional client and provider relationships.
• Work collaboratively with colleagues, including regularly providing direct support by completing team members’ tasks for them as needed.
• Understand when situational discretion must be employed in the handling and sharing of client, provider, and/or claimant information.
• Self-motivated; ability to work independently.
• Must have a high attention to detail.
• Must be coachable and receptive to feedback.
• Must be dependable and consistent.
• Ability to take a proactive approach to all situations.
• Driven by a focus on reaching a specific objective or accomplishing a given task.
• Eagerness to adapt to new methods.
• Obtain satisfaction from delivering great customer service.
• Willing to try new things/operate outside of your comfort zone.
• EDUCATION - HS Diploma or equivalent.

Benefits

• Medical, dental, prescription, and vision benefits.
• 24/7 virtual medical care.
• Employee Assistance Program for you and your family.
• 401(k) with company match.
• Company-paid life insurance.
• Supplemental insurance for yourself, your spouse/partner, and your children.
• Short-term and long-term disability insurance.
• Pre-tax Health Savings Account and Flexible Spending Accounts for Health Care or Dependent Care.
• Pet Insurance.
• Commuter accounts.