Insurance Staff Support Specialist

Here’s what you’ll be doing:

• Re-price Contract Health Services/Purchased Referred Care eligible claims to the MLR /PRC for hospital and physicians for both internal and external clients; re-price employee health claims in their designated PPO software portals; assists in the production and distribution of benefit information to members employees and clients


• Maintains database of facility CMS Rate Notifications letters and submits to data vendor as needed to ensure accurate re-pricing; updates and maintains Section 506 Recovery reimbursement data via excel spreadsheets


• Prepares and compiles documents for stop-loss and Catastrophic Health Emergency Fund reimbursements; updates and inputs pre-certifications and authorizations into claim adjudication


• Identifies documents for destruction, maintains destruction schedule and verifies documents are destroyed on site by document destruction vendor; prints and distributes daily reports and all letters generated by claims examiners


• Answers incoming customer service calls, manages departmental mail posting, sorting and distribution; assists walk-in customers promptly and courteously


• Assists Accounting Specialist with in-house check runs and creates departmental purchasing requisitions for the Director’s approval; types letters, reports, memos and create flyers as requested by supervisor

Here’s what you’ll need to be successful:

• High school diploma or GED


• Two (2) years of work experience in a medical office, medical facility, health insurance or employee benefits preferred


• Must obtain and maintain HIPAA and Insurance Marketplace CAC certification


• Knowledge of medical terminology and health/medical insurance


• Skill in operating business computers and office machines, including in a Windows environment, specifically Word, Excel, Access, and PowerPoint


• Ability to communicate effectively and represent organization in a professional manner


• Must successfully pass all applicable background checks and drug screens

Preferred qualifications:

• Four (4) years of work experience in a medical office, medical facility, health insurance or employee benefits preferred


• Experience with Indian Health Service preferred

 Benefits you’ll love:

• Approximately 5 weeks of paid time off annually


• 3 weeks of paid holidays


• Premium free health insurance


• Flexible spending accounts


• Short term disability


• Life insurance


• 401k with match