Specialty Claims Analyst (Troy, MI)
Summary
Process Disability, SUB, Flex and Death claims. Provide support for WEX Health Card users. Receive documentation from members through e-mail, fax or by hard copy mail to correctly process claims submitted by members. Assists with customer service. Full Time.
Specialty Claims Analyst Responsibilities
- Process Flex claims in the appropriate amount of time to ensure that member receives his payment in a timely manner according to the rules of the plan.
- Coordinate with Eligibility by informing them of payouts of SUB and Disability benefits to update Disability Credit Hours. Update class codes with Eligibility to process claims correctly.
- Work with the Local Halls to determine benefits for weekly SUB Payments.
- Prepare and send Disability and SUB Reports to the Local Halls on a weekly basis.
- Document appeals and notify proper contact to determine outcome for payment. Document summary of events for management to write up appeals.
- Analyst must be able to determine benefits for multiple groups to process claims correctly, and retrieve documentation required by each group for payments to go out. Outcome is either the issuing of a check or sending letters of rejection with proper appeal procedures
- Work with Pension to coordinate retirement dates, to avoid overlapping payments of both Pension and Disability simultaneously. Document Disability and SUB dates to avoid overpayments. Request refunds from members when overpayments are made.
- Run checks on assigned days weekly, for SUB, Disability, Flex and Death Benefits, advise Operations of these check runs, and coordinate with Accounting on the release of checks with RedCard. Process stop payments, voids, and refunds for all benefit types.
- Provide back-up for Customer Service and Eligibility, and take calls in assigned queue for SUB, Disability, Flex and Death Claims. Research payments according to plan rules to respond to members requests for payment of claim. Call back member with result. Ensure the member that claim was processed correctly, and the maximum benefit was received.
- Process Death Applications and gather information needed for different Life Insurance Carriers for processing of Death Benefits.
- Support Plan Manager/Associates as needed
- Proficient in Microsoft office
Specialty Claims Analyst Qualifications
- High School diploma or G.E.D. equivalent
- Prior claims experience preferred.
- Individual must be skilled in medical claims processing and knowledge of medical terminology, follow plan benefits, and good reasoning and phone skills.
- Ability to read and interpret: the plan rules as outlined in the SPD's, user manuals and department rules and procedures.
- Ability to communicate with members, union officials and co-workers the plan rules and procedures to process and issue Disability and Sub payments.
- Ability to calculate hours and Sub Credits to properly process claims for payment.
- Ability to determine tax amounts on payments.
- Ability to calculate and determine eligibility, and benefits available according to multiple plan rules, to process claims for payment.
Work Schedule
Full time. Monday - Friday 7:30am - 4:30pm. Flexible schedules available with the potential for work from home opportunities after 90 days!
Competitive Benefits & Compensation Package
- Paid Time Off (PTO)
- 15 days of PTO during the next calendar year!
- Medical, dental, vision, and life insurance
- Company paid short term disability, long term disability, and AD&D insurance
- 401k with employer match
- Tuition reimbursement program
- Paid training
- Career development opportunities
- Referral bonus for all full-time referrals
- Competitive wages
- Annual opportunities for increases and bonuses
Pay
Pay commensurate with education and experience.
Our Culture
BeneSys wants to be a great service provider to the members we serve and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees successes. We want to be a place people want to work, feel proud of what they do and feel fulfilled both professionally and personally; creating a place where employees can find long-term growth and potential.
Our culture focuses on three core values:
- Collaboration: working together across 31 locations to achieve the best for the company and our clients;
- Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues and;
- Integrity: doing what we say we will do. Upholding strong ethical and moral principles
ADA & EEO
