Mutual of Omaha Technical Benefit Specialist (Group Claims Support Services) - Omaha, NE, Chattanooga TN in OMAHA, Nebraska
Contributes to and conducts comprehensive claim reviews under the Healthy Claim Review Program to evaluate the performance and operations of internal business areas. Provides policy, process and procedural recommendations on quality results as well as training where appropriate. Reports on quality and claim related compliance issues.
Essential Job Functions:
Reviews samples of claims and analyzes claims and claim reports with respect to quality, time service and financial accuracy. Ensures compliance with applicable plan provisions, provider contracts and state and federal laws. Reviews and responds to appeals and alerts on incorrect claims.
Monitors and leads focused reviews. Develops detailed reports and quality results and provides input for corrective action.
Adheres to the supervisor review process that has been established, ensuring that objectives are met, performing quality and accuracy reviews of Benefit Claim Technician's and Benefit Claim Specialists as established. Performs issue resolution with internal staff and employers.
Establishes and promotes best practice claims management processes, and actively engages in collaborating with internal and external business partners. Facilitates and participates in team meetings and conference calls.
Communicates process changes and compliance issues to new staff.
Communicates with external and internal customers regarding specific claim information, department policies and procedures. May provide various reports to internal and/or external customers.
May assist in the work direction of day-to-day activities or act as a back-up for the Team Leader position. Participates in training, coaching, re-auditing and provides feedback to Benefit Claim Technician's and Benefit Claim Specialists.
Remains current on Company and industry changes, federal and state legislation and regulations, as well as changes in internal processes and procedures.
Identifies and eliminates waste in processes that will result in focused effort on value added service to customers. Participates in innovative and creative ways to sustain process change.
This position requires extensive or prolonged typing/keyboarding.
This position is in a fast-paced, high volume environment with set production goals. This position requires sitting over 66% of the time.
This position requires Visual Acuity at 20 inches (or less) over 66% of the time.
Minimum of 5 years experience in processing and managing Disability, Critical Illness and Accident, Long Term Care, Life and Life Waiver of Premium group claims.
Demonstrated experience with the application of policies, practices, and procedures in a business environment.
Strong knowledge / skill in presentation, electronic mail, data entry, plus PC knowledge to include various software packages, e.g. Word, Excel.
Excellent organizational skills, attention to detail with a high degree of accuracy, and the ability to work independently and apply a sense of urgency.
Ability to meet deadlines under pressure and determine when escalation may be appropriate. Strong analytical and decision-making skills.
Ability to be flexible and adapt to a changing environment.
Ability to maintain regular and predictable attendance in adherence to department and company attendance expectations.
Ability to demonstrate engagement, resilience, and a willingness to be a change champion.
- Knowledge of medical terminology.
If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at 1-800-780-0304. We are available Monday through Friday 7 am to 4:30 pm CST.
For all other inquiries, contact our HR Helpline at 1-800-365-1405.
Mutual of Omaha and its affiliates are an Equal Opportunity /Affirmative Action Employer, Minorities/Female/Disabled/Veteran
To All Recruitment Agencies: We do not accept unsolicited agency resumes and we are not responsible for any fees related to unsolicited resumes.