Casualty, Support Specialist

Full-time

Brighton Health Plan Solutions, LLC

About The Role
Provide the support necessary to grow, build and maintain the relationship between Casualty customers and network providers. Provide education and issue resolution to MagnaCare network providers and customers, for the Workers’ Compensation and No Fault lines of business. Work closely with both providers and customers, when there is a dispute raised by a network provider or customer. Maintain comprehensive knowledge of provider and company specific policies and procedures. Partner with Provider Contracting, Sales, Medical Management and Operations Department in identifying and resolving provider issues. The Support Specialist reports to the Manager of Casualty Support.
The successful candidate will be afforded an opportunity to help further structure this team. This team is a critical component to the delivery of quality healthcare services.
Primary Responsibilities
Educate providers on current policies, trends and information affecting their participation within the MagnaCare network.
Act as liaison for interpretation of No-Fault and Workers Comp contracts.
Respond to inquiries specifically related to the provider’s contract or claim issue.
Research provider contract/claim issues received by the provider or the client, and perform claims analysis.
Maintain database for provider issues and creating detailed reports as needed.
Log credentialing applications and assist with the Casualty enrollment process.
Negotiate solutions and resolve conflicts in a manner that will insure client/provider satisfaction.
Maintain provider network by negotiating/retaining key providers.
Surface issues and work with interdepartmental representatives to establish plans for resolution.
Coordinate efforts with members of the management team in developing short and long term plans that result in high performance provider services.
Assist in the development and update of provider panels.
Provide back-up and support to other Casualty departments, including Care Coordination.
Assist with Provider and/or Customer Implementations as needed.
Essential Qualifications
Superior oral and written communication skills.
Strong PC skills (excel is a must).
Knowledge of the health insurance industry, products and services.
Familiarity with claims and claims processing.
Strong follow up, negotiating and influencing skills.
Excellent problem solving skills.
Capable of managing multiple complex issues.
Ability to maintain professional demeanor under pressure.
Work well independently and as a team player.
Minimum of two years experience.
Bachelor degree or equivalent experience.

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Vacancy posted 3 days ago

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