Coordinator Of Benefits Specialist

Our client, a reputable insurance company is in search of a Coordinator of Benefits Examiner to join their team for a contract opportunity.

Location: Remote: working MST hours

Work Shift and Days: 7:30a-3:30pm MST for training (length of training depends on system experience). Hours are flexible afterwards.

Contract: 2-3 month, potential to get extended for the right candidate

Details:

• Strong coordination of Benefits experience required
• healthcare claims experience
• critical thinking
• Systems - Javelina and GBAS both would be ideal. At least 1 GBAS more preferred. System navigation training takes about 4 days. First week is learning the systems. 2nd week is training for process.

Your responsibilities will include

• Reviews claims and correspondence to make an appropriate determination on the next course of action. Identifies claims which can be fully processed or needs additional information.
• Utilizes organizational guidelines and reference materials to determine the order of Benefits and processes claims accurately.
• Investigates alternative coverage information through collaboration with external parties.
• Responds to incoming reports, medical forms and other related documents to make additional claim determinization for additional processing efforts.
• Utilizes critical thinking and reasoning skills to initiate the processing of claim refunds, or to make adjustments after investigating alternative coverage information through collaboration with external parties and the full process review has been completed, and appropriately documents such action. Researches and completes member COB, Medicare and accident questionnaires to determine how claims should be processed.