What are the responsibilities and job description for the Claims Specialist position at P & A Administrative Services, Inc?
Description
The Claims Specialist is responsible for performing complex claim adjudication duties related to Flex administration such as Section 125, 129, 132, 105(h) plans, etc. to maximize quality, quantity and total customer/client satisfaction.
Duties include but are not limited to:
- Process claims in a timely manner.
- Review and perform all claim adjustment requests.
- Research all claim reversal requests to determine approval or denial.
- Debit card disputes – Handle all fraudulent/disputed transaction requests by participants.
- Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues.
- Process manual adverse determination letters to notify participants of need for additional information, or to afford them the right to appeal, per plan rules.
- Adjudicate transactions that fail auto review & make the determination if additional information is required to approve the transaction. Process manual adverse determination letters to notify participants of need for additional information, or to afford them the right to appeal, per plan rules.
Requirements
- High School Diploma or equivalent.
- Knowledge of ERISA guidelines preferred
- Solid oral and written communication skills with strong attention to detail
- Ability to effectively manage multiple priorities utilizing effective organizational and time management practices
- Ability to effectively interact, present information, and respond to questions from customers, colleagues and management
- Self-starter with the ability to work independently in a fast-paced environment with critical deadlines
An Equal Opportunity Employer.
Salary : $16 - $18