Insurance

• Review out-of-network claims for completeness of submission.
• Validate member eligibility and policy details through use of Claims system.
• Proficient use of document management technology (Content Server) for securing and storing documents through their lifecycle.
• Works jointly with team members to manage all parts of the reimbursement process (processing claim requests, validation, payment, adjustments, audits and research); tasks can vary daily as assigned.
• Research and respond to escalated member questions regarding out-of-network and adjustments.
• Act as a liaison for member issues including benefit eligibility, claims questions, and customer satisfaction.
• Work with Claims Processing Team Lead and Benefit Relations Teams to resolve member, provider and lab reimbursement and claim inquiries.
• Complete projects as assigned by department lead or other departments.
• Perform activities and functions of related lower-level personnel as assigned or required.
• This is a remote position within the Pittsburgh, PA area. In-office may occur periodically based on business need.
• Work is performed in a home office environment and may require: occasionally lifting 0 – 20 pounds.

Claims Specialist

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