Heavy contact with providers, participants, their families and business managers. Contact with the Department management, Health Department, Eligibility Department, Pension Department and Contributions Department personnel. Daily contact with vendors (medical, prescription, dental and vision, etc.).
ESSENTIAL FUNCTIONS
Provide benefits information to providers, participants and their business managers for medical, dental and vision claims.
Handle all issues regarding the Health Plans prescription vendor; verifies benefit coverage, vacation overrides, medication authorizations by contacting client services department and by on-line updates. Also contacts various pharmacies and helps pharmacists through the authorization process.
Handle all questions regarding the Health Plans Dental and Vision benefits.
Assist the participants and providers with their calls regarding claims payment issues by researching the system, faxing or reissuing claims documentation. Work with claims examiners regarding any adjustments or questions about a claim that were discussed with the caller.
As applicable, follow up with callers to explain the resolution of the issue they originally reached out to the Health Plan about.
Review the Health Plan Summary Plan Description, medical reference books and guidelines to determine coverage of claims under the Health Plan.
Regular, predictable, and reliable attendance is required.
Ability to accept direction and developmental guidance from supervisor.
Ability to work effectively with individuals at all levels.
We are a company committed to creating inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity employer that believes everyone matters. Qualified candidates will receive consideration for employment opportunities without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, disability, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to
Human Resources Request Form. The EEOC "Know Your Rights" Poster is available
here.
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https://insightglobal.com/workforce-privacy-policy/ .
Excellent communication and interpersonal skills necessary to communicate effectively.
Ability to handle difficult phone calls and be professional at all times
Strong analytical skills
Good math skills
Excellent organizational skills and attention to detail
Self-motivated
Ability to work independently with minimal supervision
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.