Senior Consultant, Supplemental Health

• Process and adjudicate supplemental health insurance claims in accordance with company policies and regulatory guidelines
• Ensure accurate and timely claim payments while providing exceptional customer service to policyholders
• Review and evaluate supplemental health insurance claims for eligibility, completeness, and accuracy
• Verify policy information, coverage details, and applicable endorsements or riders
• Adjudicate claims using established guidelines and company policies
• Determine the accuracy of medical coding, diagnostic information, and procedure documentation
• Collaborate with the claims team to investigate and resolve any complex or disputed claims
• Ensure that claims are processed and paid in compliance with industry regulations and internal procedures
• Update claim status and maintain detailed and accurate records of all claim activities
• Communicate claim decisions, payment details, and any additional requirements to policyholders and healthcare providers
• Perform quality assurance reviews and mentor other Claims Consultants by providing feedback and identifying development opportunities with staff and management

• 5+ years of experience in supplemental health insurance claims processing or medical billing
• Strong knowledge of medical terminology, coding systems (e.g., ICD-10, CPT), and claim adjudication processes
• Familiarity with healthcare industry regulations, including HIPAA and state insurance laws
• Excellent analytical skills and attention to detail to accurately review and evaluate claim information
• Proficient in using claims management software and other computer applications
• Exceptional organizational and time management skills to prioritize workload and meet deadlines
• Excellent written and verbal communication skills to effectively interact with policyholders, providers, and internal stakeholders
• Strong problem-solving skills to resolve claim-related issues effectively and efficiently

Demonstrates expertise in supplemental health insurance claims processing, including medical coding, regulatory compliance, and effective communication with policyholders and healthcare providers. Proven ability to analyze claim information accurately and mentor team members in best practices.

• Supplemental Health Insurance Claims Processing
• Medical Coding (ICD-10, CPT)
• Claims Management Software Proficiency
• Regulatory Compliance (HIPAA, State Insurance Laws)
• Analytical Skills and Attention to Detail

• Claims Adjudication
• Medical Terminology
• Claim Evaluation
• Quality Assurance Reviews
• Problem-Solving
• Documentation Accuracy
• Eligibility Verification
• Coverage Details Assessment
• Claims Processing
• Time Management

• Exceptional Customer Service
• Organizational Skills
• Written Communication
• Verbal Communication
• Collaboration

• Healthcare Industry Regulations
• Insurance Claims
• Policyholder Interaction
• Claims Team Collaboration
• Internal Procedures

• Claims Management Software
• Computer Applications