Medical Claims Specialist Job Listing at Kelly Services in Glastonbury, CT (Job ID US3526020_BH9696606)

Description

Now Hiring: Claims Specialist - Medical Claims (Bilingual)
Position: Claims Specialist - Medical Claims (Bilingual)
Salary: $22 - $23/Hour
Schedule: 11:30AM - 8PM
Language Requirement: Bi-Lingual Spanish Speaking
Job Summary: We are seeking a dedicated and detail-oriented Claims Specialist to join our fast-paced environment. The ideal candidate will have strong interpersonal and communication skills, an outstanding ability to multi-task and prioritize, and possess strong analytical skills. This role will involve performing administrative tasks related to client health premiums and out-of-pocket medical expenses, interacting with clients to provide information in response to product and service inquiries, and resolving complaints.
Duties and Responsibilities:

1. Process or adjust medical insurance claims in accordance with policies and procedures.
2. Answer phones and respond to client inquiries related to payments made on their behalf to medical providers.
3. Respond to medical provider inquiries regarding payments made or due to their office for program clients.
4. Make outgoing calls to medical providers and insurance companies.
5. Read and understand explanations of benefits and healthcare terminology.
6. Identify, research, resolve claim issues, and request additional documentation.
7. Promote teamwork and ensure successful service delivery.
8. Ensure payment processing timeliness and accuracy meet contractual performance guarantees.
9. Ensure all client communications (phone, email, mail) meet contractual performance guarantees.
10. Process medical payments for clients.
11. Assist in the client appeals process.
12. Create and update financial batch records for processing by accounting.
13. Audit payment files and outgoing payments, ensuring accuracy.

Essential Functions: 14. Manage workflow for the team to ensure service levels are achieved. 15. Manage call logs. 16. Work with clients with high medical utilization. 17. Recommend process improvements. 18. Perform other duties as assigned.
Qualifications:

• Language Ability: Proficiency in Spanish and English
• Math Ability: Competency in basic math operations, including handling whole numbers, fractions, and decimals.
• Reasoning Ability: Apply common-sense understanding to carry out instructions furnished in various formats.
• Computer Skills: Knowledge of word processing, spreadsheet, internet software, timekeeping systems, and proprietary software. Familiarity with medical coding is strongly preferred.
• Education/Experience: Associate's degree (A.A./A.S.) or equivalent from a two-year college or technical school; or two to four years of related experience/training; or an equivalent combination of education and experience.
• Specialized Training: Knowledge of medical insurance practices, including enrollment, payment terms, benefits coordination, and ensuring the payer of last resort.

 

As part of our promise to talent, Kelly supports those who work with us through a variety of benefits, perks, and work-related resources. Kelly offers eligible employees voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability. As a Kelly employee, you will have access to a retirement savings plan, service bonus and holiday pay plans (earn up to eight paid holidays per benefit year), and a transit spending account. In addition, employees are entitled to earn paid sick leave under the applicable state or local plan. Click here for more information on benefits and perks that may be available to you as a member of the Kelly Talent Community.

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About Kelly

Work changes everything. And at Kelly, we're obsessed with where it can take you. To us, it's about more than simply accepting your next job opportunity. It's the fuel that powers every next step of your life. It's the ripple effect that changes and improves everything for your family, your community, and the world. Which is why, here at Kelly, we are dedicated to providing you with limitless opportunities to enrich your life—just ask the 300,000 people we employ each year.

Kelly Services is proud to be an Equal Employment Opportunity and Affirmative Action employer. We welcome, value, and embrace diversity at all levels and are committed to building a team that is inclusive of a variety of backgrounds, communities, perspectives, and abilities. At Kelly, we believe that the more inclusive we are, the better services we can provide. Requests for accommodation related to our application process can be directed to Kelly's Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment. Kelly participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.

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