Insurance

• Maintain ongoing knowledge of program requirements
• Analyze and process claims for accuracy, eligibility, and benefits coverage
• Retain and strengthen relationships with clients and members
• Assist members in managing and resolving reimbursement issues related to medical services and covered expenses that are medically necessary
• Correspond to verify if the amounts are related to the claim
• Develop and maintain a working knowledge of medical bill processing, procedures, and supporting systems
• Adhere to quality assurance objectives and goals
• Develop and maintain a working knowledge of all support systems to ensure ever increasing client value and Rising’s returns from administration services
• Research and utilize problem-solving skills to resolve claim discrepancies, errors, or incomplete information by communicating with providers, members, or internal departments
• Keep management updated on activities, issues and developments
• Document all claims decisions and communications with members in the system accurately and timely
• Ensure strict confidentiality of all medical information and adhere to privacy regulations and company policies
• Perform special projects as assigned by management
• Reports to: Program Manager

Medical Claims Specialist

Insurance Consultant (m/f/d)

Insurance/Billing Collection Assistant III – Department of Medicine

Insurance Billing/Collection Assistant III – Surgery

Title Insurance Assistant

Inbound Sales Center Insurance Agent, Personal Lines