Talent Solutions Group Inc is looking for a medical Benefit Specialist is responsible for providing prompt, professional, accurate and courteous service to all inquiries received by telephone involving all aspects of member health insurance from provider inquiry.The Benefit Specialist assists members and their providers by providing operational, clerical and project support for benefits. This position is the organization’s primary point of contact for members, members’ representatives, providers, and pharmacies for the pharmacy benefit and claims payment process.
Core responsibilities include customer service, claims processing, data entry, clerical support, and project support.
Health Care/Insurance environment (familiarity with medical terminology, health plan documents, or benefit plan design)
Essential Position Functions Customer Service & Claims Processing
- Communicate in a professional and respectful manner.
- Maintain confidentiality within HIPAA regulations and function on “need to know” principles.
- Respond to pharmacy benefit inquires in an accurate and timely manner to members, members’ representatives, providers, and CareOregon staff.
- Document all customer service activities according to organization requirements.
- Follow policies and procedures to answer questions from members, providers and CareOregon staff regarding claims processing as it pertains to the CareOregon pharmacy benefits.
- Follow policies and procedures to determine a resolution to pharmacy claims processing requests or triage to other CareOregon staff for assistance. Data Entry and Clerical Support
- Sort incoming faxes and distribute according to assignments.
- Maintain files according to unit protocols.
- Assist with data entry into the claims processing system, document managements systems, databases and spreadsheets as assigned. • Clerical Assistance for pharmacy projects including but not limited to:
- Distribution of education materials to members, providers or pharmacies
- Letters & mailings
- Reports Prior Authorizations (PA) & Formulary Exceptions
- Verify member’s plan eligibility and applicable pharmacy benefit.
- Educate members, providers and pharmacies and staff about the formularies and benefit policies.
- Huge plus if you have previous Medical Coding or transcription experience.
- Account management experience
- Customer Service experience
Talent Solutions Group Inc
Why Work Here?Amazing company, great opportunity for growth and advancement!
Amazing company, great opportunity for growth and advancement!