The Medical Claims Auditor reviews professional and facility claims for accuracy, compliance, and contractual adherence. They analyze medical records and itemized bills to validate billing procedures while meeting production and quality goals.
The Medical Claims Administrator coordinates the receipt, tracking, and documentation of stop loss claims submissions while ensuring accuracy and compliance. They also perform quality assurance monitoring, compile periodic reports for stakeholders, and facilitate funding with the finance department.
The Stop Loss Claims Specialist is responsible for compiling, submitting, and managing stop loss claims to carriers for reimbursement. They also handle large case notifications, resolve carrier inquiries, and maintain accurate documentation in compliance with internal and regulatory standards.
The Sales Operations Analyst will analyze prospective client health insurance data to determine potential savings and inform network strategy. They will also collaborate with sales teams to provide data-backed fee recommendations and support the overall sales process.
Assist members with balance bill setup and related inquiries, enter account information accurately, and coordinate documentation with audit teams and third-party partners. Route and track inquiries, maintain complete records and follow-ups, and collaborate across teams to resolve service issues and improve processes.
The Member Services Support Specialist manages member caseloads for terminated accounts, providing specialized support and education regarding balance billing. They act as a primary point of contact to facilitate issue resolution while collaborating with legal teams and external stakeholders.
The Supervisor, Case Management oversees a team of case managers, ensuring clinical quality, compliance with medical necessity standards, and effective delivery of health plan services. They are responsible for performance management, staff training, auditing, and collaborating on policy implementation to meet accreditation requirements.
The Claims Correspondence Review Specialist is responsible for researching and resolving client claims inquiries while interpreting plan documents. They must provide timely customer service via phone and email while maintaining quality assurance standards.
The associate will manage client and member relationships by identifying strategic initiatives and facilitating innovative solutions to ensure engagement. They will also act as a member advocate, guiding individuals through the balance bill defense process and resolving escalated issues.
The Communications and Engagement Specialist manages custom member education campaigns by developing content, deploying strategies, and tracking success rates. They collaborate with HR leaders and brokers to deliver effective communications while overseeing vendor coordination and digital engagement initiatives.
The Sr. Plan Document Specialist is responsible for drafting, reviewing, and maintaining employee benefit plan documents and Summary Plan Descriptions for self-funded health plans. They serve as a subject matter expert to ensure compliance with federal regulations while collaborating with internal stakeholders to deliver accurate documentation.
The Relationship Manager is responsible for overall client satisfaction, managing the onboarding process, and providing superior service to brokers and employers. They act as a liaison between internal staff and clients while identifying revenue opportunities and ensuring successful plan renewals.
The specialist is responsible for reviewing and validating PBM vendor invoices to ensure accuracy and compliance with contractual agreements. They reconcile billed fees against claims data and coordinate with vendors and internal managers to resolve billing discrepancies.
