Specialty Claims Analyst (Troy, MI)

Please see below for a current listing of available positions at BeneSys. Position: Specialty Claims Analyst (Troy, MI) Location: Troy, MI Job Id: 2647 # of Openings: 1 Specialty Claims Analyst (Troy, MI) Summary - The Specialty Claims Analyst will process Disability, SUB, Flex, and Death claims. Provide support for WEX health card users and receive documentation from members through e-mail, fax or by hard copy mail to correctly process submitted claims. Assists with customer service. Applicants for this remote role will only be considered if they live in these locations: Illinois, Indiana, Iowa, Kentucky, Michigan, Missouri, Ohio, Oregon, Pennsylvania, Wisconsin. Essential Duties and Responsibilities include but not limited to Process Flex claims in the appropriate amount of time to ensure that member receives payment in a timely manner according to the rules of the plan. Coordinate with Eligibility by informing them of payouts of SUB and Disability benefits to update disability credit hours. Work with the Local Halls to determine benefits for weekly SUB payments. Prepare and send Disability and SUB Reports to the Local Halls on a weekly basis. Determine benefits for multiple groups to process claims correctly, and retrieve documentation required by each group for payments to go out; outcome is either the issuing of a check or sending letters of rejection with proper appeal procedures. Work with Pension to coordinate retirement dates, to avoid overlapping payments of both Pension and Disability simultaneously. Document Disability and SUB dates to avoid overpayments; request refunds from members when overpayments are made. Run checks on assigned days weekly, for SUB, Disability, Flex and Death Benefits, advise Operations of these check runs, and coordinate with accounting on the release of checks. Process stops payments, voids and refunds for all benefit types. Provide back-up for Customer Service and Eligibility; take calls in assigned queue for SUB, Disability, Flex and Death Claims. Research payments according to plan rules to respond to members requests for payment of claim; call back members with result. Ensure the member that claim was processed correctly, and the maximum benefit was received. Process death applications and gather information needed for different life insurance carriers for processing of death benefits. Maintain claims processing quality standards of at least 98%. Maintain claims turnaround times as defined by Specialty Claims Management based on type of claim assigned (claim TAT varies based on SUB, MRA, disability or death) Support Plan Manager/Associates as needed. Regular and predictable attendance is an essential function of this job. Qualifications - Individual must be skilled in medical claims processing and knowledge of medical terminology. Have two (2) years of experience in a related field, required. Good reasoning and phone skills. Proficient in Microsoft office. Education and/or Experience - High School diploma or GED equivalent. Prior claims experience preferred. Language Skills - Ability to read and interpret the plan rules as outlined in the SPD (Summary Plan Description), user manuals and department rules & procedures. Ability to communicate with members, union officials and co-workers the plan rules and procedures to process & issue Disability and SUB payments. Mathematical Skills - Ability to calculate hours and SUB Credits to properly process claims for payment. Ability to determine tax amounts on payments. Reasoning Ability - Ability to calculate and determine eligibility & benefits available according to multiple plan rules to process claims for payment. Competitive Benefits and Compensation Package 12 paid holidays Paid Time Off (PTO) Pro-rated during first year of employment 15 days of PTO provided in the next calendar year! Up to 20 days paid jury leave Medical, dental, and vision insurance, with option for dependent coverage Company-paid basic life, short-term disability, long-term disability, and AD&D insurance 401k with employer match Referral bonus for all successful full-time referrals Annual opportunities for increases Pay The pay range for this position is $21.00 - $24.00 an hour. Actual salary is dependent on skills, experience, education, and other business factors. Our Culture BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees' successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential. Our culture focuses on three core values: Collaboration: working together across 31 locations to achieve the best for the company and our clients Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues Integrity: doing what we say we will do. Upholding strong ethical and moral principles

ADA & EEO

Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job. #J-18808-Ljbffr BeneSys, Inc.