Claims Concierge Specialist

Location

Ridgeland, MS | United States

Job description

The Claims Concierge Specialist reports to the Claims Department Manager in the MWG-Administrators Division.

The position is a nonexempt, hourly role and is located at 500 Steed Road, Ridgeland, MS 39157.

GENERAL JOB DUTIES AND RESPONSIBILITIES:

The Claims Concierge Specialist is an advocate to our customers throughout the lifecycle of their claim. They are center stage when it comes to answering questions. He or She will listen to our customers' needs and make sure the claims process is simple. They are also responsible for providing the business with feedback from our customers to continue to drive process improvements and will communicate with the Claims Manager daily as well as possibly interacting with groups, claimants, outside carriers, and agents. To perform the job successfully, the employee must be able to perform each essential duty satisfactorily. The requirements listed here are representative of the knowledge, skill, and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Maintain a 24-48-hour turn-around on processing claims and responding to any inquiries.
• Directly assist Agents, Members, Providers and Broker Services.
• Maintain Concierge Email/Faxes and Maintain Concierge Tickets
• Take direct calls on the Concierge Phone Line
• Provide in-depth assistance and immediate resolution of all received inquiries
• Generate Itemizations, Process Prior Deductible Credits, and Provide Complete Member Audits
• CMRP Claims and Assistance
• Validate HIPAA forms
• Process EOBs, Billing Statements & Proof of Payments
• Process Claim Adjustments
• Calculate correct coordination of benefits (COB) Claims
• Review Claim Appeals
• Moving Balances (buckets)
• Utilize MWG-Administrators Policy Administration System and Claims Management Software to verify eligibility and review member accounts based on the policy assigned.
• Input data into MWG Administrators Claims Management Software.
• Be knowledgeable and have a clear understanding of the business processes within Morgan White Group.
• Perform other duties as assigned by the Department Manager.

EXPERIENCE AND EDUCATION REQUIREMENTS:

• High School Diploma or GED required; Associates or bachelor's degree is preferred.
• Must have 1-2 years of previous insurance claims experience.
• Must be proficient in computer skills and have strong knowledge of Microsoft Outlook, Windows, Excel, and Word.
• Must be able to learn and be proficient with the software using in the TPA Department.
• Must possess time management, organizational, problem solving, and customer service skills.
• Must be able to work well under pressure with multiple priorities and meet deadlines.
• Must be able to multitask while maintaining attention to details.

WORKING ENVIRONMENT:

• Must be able to perform in a very high paced environment and professionally handle interruptions.
• Must have the ability to work under minimal supervision.
• Must be able to prioritize projects, work multiple projects simultaneously, and meet project deadlines.
• Must possess excellent problem-solving skills and have keen attention to details.
• Must demonstrate strong written and verbal communication, interpersonal, and relationship building skills.
• Must be able to handle stressful situations appropriately.
• Must maintain confidentiality and privacy in every aspect of the job.

JOB ESSENTIAL REQUIREMENTS:

The following are job functions that an employee must be capable of performing with or without reasonable accommodation.

• Must be able to read, write, and speak English; Spanish is a plus.
• Must have basic typing skills
• Must be able to work as scheduled.
• Must possess sight and hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of the position as stated above can be fully met.
• Must be able to bend, stretch, reach, and sit or stand at a desk during 85% of the workday.
• Must be able to lift, stoop, and carry small equipment items and supplies, possibly weighing up to 20lbs.

REASONABLE ACCOMODATIONS:

Morgan White Group will reasonably accommodate qualified individuals with a disability so that they can perform the essential functions of a job, unless doing so causes a direct threat to these individuals or others in the workplace and the threat cannot be eliminated by reasonable accommodation or if the accommodation creates an undue hardship to Morgan White Group.

EQUAL OPPORTUNITY EMPLOYER:

MWG is an Equal Opportunity Employer, committed to the principles of the EEOC. All employment decisions are based upon each person's qualifications, abilities, and performance. Our company works to provide an environment where human dignity prevails and all employees and applicants for employment receive equal consideration and fair treatment, without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Job tags

Salary