Claims Specialist - Exton, PA

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West s Health Advocate team is looking to hire Claims Specialists for our Exton, PA location.
As a Claims Specialist, you would be responsible for the following duties:
  • Handle some complex cases in a timely manner to identify opportunities to resolve the issue by working with plan documents, carriers, providers and members
  • Research plan information and identify where there may be conflicting information. Escalate as needed to supervisor or other levels of management for clarification and assistance
  • Research billing issues to determine the possible cause of the error and assisting with claims resubmission when needed to correct the issue
  • Assist members with setting up payment arrangements
  • Utilize all resources available to analyze and resolve billing issues
  • Plan documents including SPD s, benefit summaries and open enrollment materials, interpretation of benefits
  • Understanding of medical, dental, vision, behavioral health
  • Assist with billing and claims adjudication process
  • Understanding of FSA, HRA and HSA plans
  • Serve as a resource of help to other claims specialists who need assistance and have questions on their cases
  • Mentor new employees

Education

  • Bachelor s degree and/or 2-3 years claims experience

Experience

  • Strong research and analytical skills
  • Ability to work independently and escalate for assistance as needed
  • Strong communication ability to work with various internal and external parties to resolve member issues
  • Excellent organizational and time management skills
  • Ability to proactively identify payer and provider trends, and to communicate this to management
  • Excellent customers service skills
  • Excellent listening skills and ability to emphasize with members
  • Excellent computer skills and experience in Microsoft Office Suite

West is connecting people and ideas.
We are delivering on their potential.
We are improving the way we work and live.

At West, we are dedicated to delivering and improving upon new channels, new capabilities and new choices for how businesses and consumers collaborate, connect and transact. We develop technology-enabled communications that change the way we work and improve the way we live. We are a collective effort of enterprise and individuals, of communities and customers, of partnerships and families. We are the sum of our entire network the result of brilliant ideas, dedication and the hard work of people who share our vision. We are at the core of a technology and communications engine that is changing the world.


We connect. We deliver. We are West.

Applications accepted through 12/23/16.


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