FAQs
What is the primary role of a Claim Benefit Specialist OPS?
The primary role of a Claim Benefit Specialist OPS is to review and adjudicate routine claims in accordance with claim processing guidelines, analyze claims that cannot be auto adjudicated, apply medical necessity guidelines, determine coverage, and assist in the claim adjudication process.
What qualifications are required for this position?
The required qualifications for this position include experience in a production environment, claim processing experience, and a High School diploma or GED equivalent.
What are some preferred qualifications for this role?
Preferred qualifications for this role include experience with Medicaid, familiarity with QNXT, and knowledge of medical coding.
What does the pay range look like for this position?
The typical pay range for this role is $17.00 - $28.46 per hour, depending on factors such as experience, education, and geography.
What kind of benefits are offered to employees?
Employees enjoy a full range of medical, dental, and vision benefits, access to a 401(k) retirement savings plan, Employee Stock Purchase Plan, fully-paid term life insurance, disability benefits, well-being programs, education assistance, and paid time off, among other benefits.
Is training provided for this position?
Yes, training may be facilitated as needed, particularly when the employee is considered a subject matter expert on specific topics.
Can I apply for this position if I have an arrest or conviction record?
Yes, qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.
What type of claims will I primarily be handling?
You will primarily handle routine claims and may also route and triage complex claims to Senior Claim Benefits Specialists.
What systems will I be using in this role?
In this role, you will utilize various system functions, including claim check, reasonable and customary data, and the Electronic Correspondence Handling System (ECHS) for processing claims and correspondence.
When does the application window for this position close?
The application window for this opening is anticipated to close on 02/17/2025.