Position Summary
The Claims Coordinator represents the organization in a professional manner and interacts effectively with diverse stakeholders to deliver outstanding service. This role maintains day-to-day internal claims processing operations and collaborates closely with client-facing teams and outsource partners to enhance claims efficiency, accuracy, and operational capacity. The Claims Coordinator works under general supervision to ensure compliance with service level agreements (SLAs).
Principal Duties & Responsibilities:
Claims Processing & Operations:
Monitor and respond to specified Jira ticketing queues in the Jira Claims project. (Intermediate)
Act as an operational resource regarding claims services and procedures, responding to daily inquiries and specific claim questions from outsource partner(s) via the Jitbit claims processing system. (Intermediate)
Assist outsource partners and Account Management teams with reporting requests. (Intermediate)
Review and process Letters of Medical Necessity and Prescriptions submitted by account participants in accordance with IRS guidelines. (Beginner)
Process Improvement & Quality Assurance:
Identify potential processing bottlenecks, system issues, and opportunities for workflow enhancements. (Intermediate)
Monitor and analyze consistent errors or recurring questions from outsource partners and internal staff. (Intermediate)
Collaborate with the Claims Department Supervisor to refine training materials, update processor documentation, and share best practices to minimize recurring error rates. (Advanced)
Perform ad hoc projects and additional responsibilities as assigned by department leadership. (Beginner)
Knowledge, Skills, and Abilities Required:
Claims Processing & Technical Skills:
Claims & TPA Knowledge: Working knowledge of third-party administration (TPA), consumer-directed health benefits, and claims adjudication processes. (Intermediate)
Technical Proficiency: Proficiency in Microsoft Office/Google Workspace and experience navigating Jira and Jitbit. (Intermediate)
Claims Knowledge: Proficiency in claims processing workflows, manual adjudication, and appeals. (Intermediate)
Software Capability: Aptitude for mastering and using proprietary claims processing systems.(Intermediate)
Analytical Proficiency: Ability to analyze complex data, identify discrepancies, and accurately calculate and process adjustments in the claims system. (Intermediate)
Data Analysis & Problem Solving: Demonstrated capability to evaluate complex data, identify discrepancies, and accurately calculate adjustments. (Intermediate)
Regulatory Knowledge: Knowledge of consumer-directed health benefits regulations and all relevant HHS standards for the secure handling of Protected Health Information (PHI). (Intermediate)
Technical Skills: Proficiency in Microsoft Office/Google Workspace and experience navigating Jira and Jitbit. (Intermediate)
Communication & Discretion: Excellent written, verbal, and interpersonal communication skills to explain complex issues to various stakeholders; strong email etiquette and proven ability to handle confidential information with tact and discretion. (Intermediate)
Credentials & Experience:
Education & Experience:
Graduation from an accredited college, university, or technical school is required.
Background or experience in Benefits Administration.
Prior experience in claims processing, TPA operations, or customer service is preferred.
BENEFITS
Medical Insurance
Vision Insurance
Dental Insurance
401(k) Matching
Flexible Spending Accounts
Health Savings Accounts
Disability & Life Insurance
Employee Assistance Program
LegalShield
ID Shield
Commuter Reimbursement Plan
Tuition Reimbursement
Bonus Pay
ADDITIONAL BENEFITS INCLUDE:
Wellable membership
Telescope Health (telehealth) through Accresa
Intellect (mental health) application
Employee engagement activities, including voluntary events, raffles, book club, and more!
PHYSICAL DEMANDS AND WORKING CONDITIONS:
Work in an office environment; sustain posture in a seated position for prolonged periods of time; use hands to grasp and reach; occasionally stoop or kneel; see, hear, and speak with sufficient acuity to successfully perform all aspects of the job; use telephone and write or use a keyboard to communicate through written means; lift up to ten pounds of weight.