Lead Claims Specialist

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc.

(UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

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Job Summary: The Lead Claim Specialist is the first point of contact for the Claims team. Responsibilities include fielding and answering inquiries about processing commercial, ASO and Medicare claims to ensure quality service is being delivered to health plan members, employer groups, brokers, insurance carriers, and provider offices. This role will also promote quality, superior customer service, and will identify enhancements and changes to workflow processes to increase efficiencies, effectiveness and productivity.

Will provide on‑going feedback to the Claims Supervisor of what is working and where there are areas of improvement/growth.

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
  · More information is available on our Benefits Guest Website:

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

• Associate’s degree or equivalent experience
• 3 years of Insurance claims processing experience
• 2 years’ experience working with health plans insurance products or employer healthcare benefits programs
• Knowledge of State and Federal regulations as they pertain to the health insurance industry
• Possesses strong/broad understanding of the claims analyst process, medical/dental terminology, and claims processing procedures
• Superior Customer Service skills --- seeks to understand expectations of internal and external customers. Knows which questions to ask and what information to verify to get to the root cause of a problem
• Ability to communicate clearly and professionally in English, both verbally and in writing with both internal/external customers
• Excellent presentation skills and ability to conduct effective meetings and training sessions
• Strong time management, organizational, analytical, and problem‑solving skills
• Intermediate proficiency with Microsoft Office (Word, Excel, PowerPoint, Outlook)
• Takes initiative to research, resolve processing and system issues using available resources without direction. Diligently follow‑ups with Director, peers, other departments, and customers
• Oriented toward continuous improvement offering ideas and solutions to change or enhance processes or system obstacles; ability to organize and document workflows and processes
• Results orientated with an understanding of where tasks and assignments fall into the big picture and organizes and prioritizes accordingly. Gets more out of few…