Job Description

Description:

Position is REMOTE but must be local to the office location. Handle end-to-end processes associated with EAP claim data management by adhering to policies/procedures and compliance. Identifies and addresses issues impacting EAP claim adjudication. Achieve superior claim and provider service performance through an integrated process of operational, quality, and resource management meeting and/or exceeding provider expectations. JOB DUTIES

• Analyze and adjudicate routine and complex EAP provider claims and meet/exceed a daily adjudication target
• Handle check research that includes stop payments, voids, and refunds
• Handle overpayment recovery
• Research and resolve provider reconsiderations
• Handle 1099 Misc inquiries
• Recommend process enhancements in a changing environment
• Participate in drafting/maintaining policies and procedures
• Participate in audits and/or assigned projects. EXPERIENCE REQUIRED
• Previous claim processing experience and customer service experience is desired.
• Experience with Microsoft Outlook, Excel, and Word.
• Attention to detail is a must.
• Must be able to thrive in a production environment by meeting and/or exceeding the department's standards for production and quality metrics with proven time-management skills is required.