Job Description

The HT Group has partenered with a company within the Health Insurance industry to hire a Claims Eligibility Specialist II.
This position will be a Direct Hire Remote position. Must have LVN, LPN or LSW designation.
As a Claims Eligibility Specialist II, you will play a critical role in reviewing and managing claims of varying complexity. You’ll work closely with a collaborative team, supporting the accurate and timely processing of claims while ensuring a high-quality customer experience. This is a great opportunity for someone with a strong background in claims and a desire to grow in a fast-paced, mission-driven environment.
ESSENTIAL JOB FUNCTIONS
Investigates, maintains, and supports others in managing cases of varying complexity, including but not limited to:
Reviews and evaluates coverage and / or liability.
Analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, records, or other documents) to determine eligibility claim decisions.
Establishes appropriate Plan of Care according to Claim Handling Guidelines
Manages short-term/limited approval claims.
Assists with complaints/appeals.
Conveys more complex information (coverage, decisions, outcomes, etc.) to all appropriate parties, maintaining a professional demeanor in all situations.
Ensures claims handling is conducted in compliance with applicable statues, regulations, and other legal requirements, and that all applicable company procedures and policies are followed.
Works closely with Team Lead(s), and can provide back up support to the Team Lead(s)
Provides guidance and support to lower-level positions and other functional areas and other duties as assigned.
Qualifications
5+ years of related experience in claims management and review, with experience in the insurance industry and with related products a plus.
Bachelor’s degree in LVN, LPN, LSW, Business or a related field, or equivalent years education/experience
Possesses a high level of technical knowledge and skills related to claims management and review
Communicates effectively, both orally and in writing, with empathy and strong listening skills
Performs work under limited supervision.
*HPIND

Job Tags

Temporary work, Remote job,

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Claims Eligibility Specialist 2 (Remote) Job at The HT Group, Austin, TX

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