Description
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
This position is responsible for providing on and off-site services and assistance to account employees, management representatives and union benefits representatives on matters concerning claims, inquiries, benefit levels and all matters connected with a major account in addition to performing tracking and reporting functions regarding claims, inquires and new group implementation; and acting as liaison between groups and internal departments. This position requires extensive working knowledge of claims processing, to include the ability to review claim level data to determine payment methodology. Consultative advisor to Sales & Account Manager and clients to ask probing questions, define root cause, and develop long term solutions. Also serves as lead on customer audits, and acts as support for GBS I.Required Job Qualifications:
*Bachelors Degree OR 4+ years customer service or claims experience in a health care or health insurance environment.
*Completion of training and SME for claims system capabilities and/or process in one of the following systems: Facets, Blue Chip, QNXT, etc
*Extensive knowledge of benefit provisions of group contracts and system interface skills.
*3+ years experience resolving complex claims.
*1+ years experience investigating and resolving corporate audit and/or departmental cited errors.
*Extensive knowledge of medical and industry terminology, and some familiarity with industry standards.
*Clear and concise verbal and written communication skills.
*Analytical, interpersonal and organizational skills. Experience analyzing complex issues and determining next steps.
*Experience multi-tasking, making decisions, prioritizing workflow, working independently and meeting deadlines.
*Ability to travel including overnight stay as necessary.
*Experience acting as lead in group and/or team settings.
Preferred Job Qualifications:
*PC/Software proficiency to include Word, Excel, PowerPoint and Outlook, as well as BC Production, Web-Ex, Self-Reporting Tool, Salesforce, and Sharepoint.
*Marketing experience.
*Experience presenting to external clients.
*Knowledge of OR experience with Medicaid
HCSC Employment Statement:
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
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