Benefits Representative

Lincoln, RI 02865

Post Date: 07/26/2018 Job ID: 28512 Category: Professional

Position Summary:
  • In this role, you will analyze client benefit requests, determine best operational approach, and perform coding.
  • You will validate coding accuracy utilizing various tools to ensure no financial impact or client/participant dissatisfaction.
  • In addition, this position is responsible for meeting or exceeding turnaround time and quality standards.
  • You will be researching client benefit requests/issues and recommend alternative solutions to internal partners in meeting client needs.

Duties:
  • In addition to coding, this position will also be responsible performing QA functions such as moving all plan design implementations and/or changes into a Production status upon completion of a review within tight timelines.
  • This position may support coding and QA activities for commercial clients as well as clients with federal/state programs (such as Medicare D, Medicaid, MAPD, RDS, COB, EGWP, HealthCare Reform, etc.).

Required Qualifications:
  • 2+ years of professional work experience in Claims, Insurance, QA, Testing, or a high-production environment.

Preferred Qualifications:
  • Previous work experience in a PBM, Medical Claims, Health Insurance, Pharmacy, or Benefits highly preferred.
  • Well organized with the ability to effectively prioritize work.
  • Ownership and results driven.
  • Customer focused.
  • Attention to detail.
  • Able to meet aggressive turnaround time standards/client performance guarantees coupled with excellent quality.
  • Proficient use Microsoft Office applications, e.G. Excel, Word.
  • Ability to effectively work within a team.
  • Flexible in adapting to change.
  • Demonstrated ability to analyze data and determine conclusions.
  • Ability to learn and apply increasingly complex concepts, policies and procedures.
  • Ability to effectively plan, prioritize, organize time and workload.
  • Skilled in identifying and solving issues and recommending process improvements.
  • Ability to work successfully in a deadline-oriented environment.
  • Excellent verbal and written communication skills.
  • Project Management skills.

Education:
  • High School Diploma/GED required Bachelor's degree preferred.

For more information on this position, please contact our office at 877-782-3334.

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