Specialty Claims Analyst; Troy, MI

Summary - The Specialty Claims Analyst will process Disability, SUB, Flex, and Death claims. Provide support for WEX health card users and receive documentation from members through e-mail, fax or by hard copy mail to correctly process submitted claims. Assists with customer service.

• Process Flex claims in the appropriate amount of time to ensure that member receives payment in a timely manner according to the rules of the plan.
• Coordinate with Eligibility by informing them of payouts of SUB and Disability benefits to update disability credit hours.
• Work with the Local Halls to determine benefits for weekly SUB payments.
• Prepare and send Disability and SUB Reports to the Local Halls on a weekly basis.
• Determine benefits for multiple groups to process claims correctly, and retrieve documentation required by each group for payments to go out; outcome is either the issuing of a check or sending letters of rejection with proper appeal procedures.
• Work with Pension to coordinate retirement dates, to avoid overlapping payments of both Pension and Disability simultaneously.
• Document Disability and SUB dates to avoid over payments; request refunds from members when over payments are made.
• Run checks on assigned days weekly, for SUB, Disability, Flex and Death Benefits, advise Operations of these check runs, and coordinate with accounting on the release of checks.
• Process stops payments, voids and refunds for all benefit types.
• Provide back-up for Customer Service and Eligibility; take calls in assigned queue for SUB, Disability, Flex and Death Claims.
• Research payments according to plan rules to respond to members requests for payment of claim; call back members with result. Ensure the member that claim was processed correctly, and the maximum benefit was received.
• Process death applications and gather information needed for different life insurance carriers for processing of death benefits.
• Maintain claims processing quality standards of at least 98%.
• Maintain claims turnaround times as defined by Specialty Claims Management based on type of claim assigned (claim TAT varies based on SUB, MRA, disability or death).
• Support Plan Manager/Associates as needed.
• Regular and predictable attendance is an essential function of this job.

Qualifications - Individual must be skilled in medical claims processing and knowledge of medical terminology. Have two (2) years of experience in a related field, required. Good reasoning and phone skills. Proficient in Microsoft Office.

Location - Applicants for this remote role will only be considered if they live in these locations:
Illinois, Indiana, Iowa, Kentucky, Michigan, Missouri, Ohio, Pennsylvania, Wisconsin.

Education and/or Experience - High School diploma or GED equivalent. Prior claims experience preferred.

Language Skills - Ability to read and interpret the plan rules as outlined in the SPD (Summary Plan Description), user manuals and department rules & procedures. Ability to communicate with members, union officials and co-workers the plan rules and procedures to process & issue Disability and SUB payments.

Mathematical Skills - Ability to calculate hours and SUB Credits to properly process claims for payment. Ability to determine tax amounts on payments.

Reasoning Ability - Ability to calculate and determine eligibility & benefits available according to multiple plan rules to process claims for payment.

Work Schedule - Full time. Monday - Friday, 7:30am - 4:30 pm. Permanent Remote position (No in-office days).

• 12 paid holidays
• Paid Time Off (PTO)
  • Pro-rated during first year of employment
  • 15 days of PTO provided in the next calendar year!
• 3 days paid bereavement
• Up to 20 days paid jury leave
• Medical, dental, and vision insurance, with option for dependent coverage
• Company-paid basic life, short-term disability, long-term disability, and AD&D insurance
• 401k with employer match
• Tuition reimbursement program
• Career development opportunities
• Referral bonus for all successful full-time referrals
• Annual opportunities for increases

Pay - The pay range for this position is $22.00 - $24.00 an hour. Actual salary is dependent on skills, experience, education, and other business factors.

Bene Sys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees' successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally.

We want to create a place where employees can find long-term growth and potential.

Our culture focuses on three core values:

• Collaboration:
  
  working together across 31 locations to achieve the best for the company and our clients
• Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our…