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Forest County Potawatomi Community Linkedin · Posted 1mo ago

Insurance Staff Support Specialist

Crandon

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Indexed description

Here’s What You’ll Be Doing

  • Re-price Contract Health Services/Purchased Referred Care eligible claims to the MLR /PRC for hospital and physicians for both internal and external clients; re-price employee health claims in their designated PPO software portals; assists in the production and distribution of benefit information to members employees and clients
  • Maintains database of facility CMS Rate Notifications letters and submits to data vendor as needed to ensure accurate re-pricing; updates and maintains Section 506 Recovery reimbursement data via excel spreadsheets
  • Prepares and compiles documents for stop-loss and Catastrophic Health Emergency Fund reimbursements; updates and inputs pre-certifications and authorizations into claim adjudication
  • Identifies documents for destruction, maintains destruction schedule and verifies documents are destroyed on site by document destruction vendor; prints and distributes daily reports and all letters generated by claims examiners
  • Answers incoming customer service calls, manages departmental mail posting, sorting and distribution; assists walk-in customers promptly and courteously
  • Assists Accounting Specialist with in-house check runs and creates departmental purchasing requisitions for the Director’s approval; types letters, reports, memos and create flyers as requested by supervisor

Here’s What You’ll Need To Be Successful

  • High school diploma or GED
  • Two (2) years of work experience in a medical office, medical facility, health insurance or employee benefits preferred
  • Must obtain and maintain HIPAA and Insurance Marketplace CAC certification
  • Knowledge of medical terminology and health/medical insurance
  • Skill in operating business computers and office machines, including in a Windows environment, specifically Word, Excel, Access, and PowerPoint
  • Ability to communicate effectively and represent organization in a professional manner
  • Must successfully pass all applicable background checks and drug screens

Preferred Qualifications

  • Four (4) years of work experience in a medical office, medical facility, health insurance or employee benefits preferred
  • Experience with Indian Health Service preferred

Benefits You’ll Love

  • Approximately 5 weeks of paid time off annually
  • 3 weeks of paid holidays
  • Premium free health insurance
  • Flexible spending accounts
  • Short term disability
  • Life insurance
  • 401k with match
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