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Benefits & Claims Services Associate
Description
Reporting to the Manager of Claims & Customer Service, you will be responsible for assisting members, providers, brokers, and employers with benefit inquiries, claims processing, eligibility, network, and medical management questions.
The ideal candidate will have a strong background in health insurance and claims processing, along with excellent customer service and problem-solving skills.
What you’ll do
- Receive phone calls and written inquiries regarding benefits, claims, eligibility, and other business areas.
- Process medical, dental, and vision claims as directed.
- Provide accurate and timely responses to client inquiries.
- Process incoming requests according to established department policies and procedures.
- Conduct research and investigative activities to resolve inquiries fully.
- Collaborate with team members and other departments to resolve and escalate inquiries as needed.
- Provide timely feedback to customers through outbound calling, email, or mail.
- Report service failures, systemic issues, or customer concerns to management.
- Assist in completing special projects and evaluating and revising department policies and procedures.
- Document and write policies & procedures as needed.
- Meet or exceed service level agreements for the member services team.
- Attend and participate in meetings and training sessions as required.
- Perform other duties as assigned.
What you’ll bring
- Minimum of 2 years of experience in health insurance and 1 year of claims processing experience.
- Expert-level knowledge of CPT/CDT/ICD coding.
- Strong understanding of healthcare billing and claims.
- High level of resolution skills and proficiency in managing confidential information.
- Clear verbal and written communication skills.
- Proficiency in Word, Excel, and computer skills at an experienced level.
Join our client’s team and help us deliver exceptional service to our clients while contributing to a positive and dynamic work environment. Apply today to make a meaningful impact!
Caymanians or those with Caymanian rights to work need only apply.