Graduate Medical Management Specialist

Job description

·  Job Description:

Summary

Processes complex claims to ensure accurate and timely completion. Assists in the processing of highly complex claims under the oversight of a higher level examiner. Assists in negotiating claims settlements.

Essential Job Functions

·  Conducts correspondence related to client requests for information.
·  Evaluates available information to validate claims. Verifies policyholder information, policy effective dates, premium status and verification of claim eligibility.
·  Identifies need for additional information; contacts appropriate source to obtain needed information. Verifies beneficiary or claimant information if claim is warranted. Identifies payment amount and obtains required management approvals for payment. Processes payment.
·  Investigates moderate to highly complex claims and determines level or resolution if appropriate; advises claimant of status; assists in negotiating settlement and resolution of claim.
·  Receives demand letters; researches and investigates claims, responds within individual parameters and escalates as appropriate.

Basic Qualifications

·  High school diploma or G.E.D.
·  Fellowship of Life Health Claims (FLHC) Certification preferred
·  Four or more years of insurance/claims processing experience
·  Experience working with insurance and/or medical terminology
·  Experience working with appropriate claims processing procedures and documentation

Other Qualifications

·  Good analytical and problem solving skills
·  Good interpersonal skills to interact with team members
·  Good communication skills to communicate with clients
·  Good negotiation skills to interact with claimant
·  Ability to keep sensitive and confidential material private
·  Ability to work in a team environment

Work Environment

·  Office environment