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Benefits Consultant 1
Ref No.: 18-28918
Location: Omaha, Nebraska
CLAIM 
Claim Benefit Specialist 
As a Claim Benefit Specialist, you will enter a challenging, fast pace but rewarding position while providing amazing member experience for our customers. Ultimately, this will enable the delivery of the PayFlex Mission Statement by driving compassion, confidence, and trust while delivering one superior quality experience at a time. 
This role requires attention to detail to ensure we are processing the claim accurately to ensure a great member experience based on the claim form they’ve submitted for reimbursement. 
This journey begins as a temporary position with potential for fulltime with benefits. 


Effective Communication –It is critical to be able to effectively use resources that are available and communicate clearly with your leads/supervisors on any further assistance needed to accurately process the reimbursement claim form that has been submitted by the member. Ability to maintain a professional attitude and respect for peers in the workplace. (i.e. caring, empathy, positive attitude and tone) to drive effective communication amongst your peers. 
Detail Oriented – Monitors and checks work or information and plans and organizes time and resources efficiently. Key Words: Quality Assurance, Thoroughness, Efficiency. 

Decision Making / Problem Solving- making use of available tools and resources to make informed decisions while processing claims. 


Work Independently- When assigned a task(s) you take ownership and don't require constant assistance or supervision to complete that task(s). Once assigned to a claims work queue be able to complete the task with sufficient details to accomplish accuracy while processing. 

Training – Up to 4 weeks of robust formal classroom training will be executed. Completion of quizzes to check overall understanding and completion to continue to process claims effectively. 

Reliability – Upon completion of training, a schedule of 8:00am-5:00 pm cst (with the potential of mandatory/voluntary ot hours during the week.) Attendance and punctuality is a must for being successful at PayFlex-ability to work Mandatory Saturday’s as they are needed. 

Key Responsibilities 
Accountable for accurately adjudicating claims and determining eligibility for Flexible Spending Accounts, Dependent Care Accounts and Health Reimbursement Accounts. XXXXXXXXX (what are they doing? Are they adjudicating, are they sending claims to different levels, are they making decisions on a claim to be paid or not be paid?? cy and production standards (what are they??) 
Resolves difficult claims (what defines a difficult claim? Do the claims get reviewed by others? using available resources and makes decisions with minimal management intervention. 
Strong attention to detail needed to maintain accuracy while processing. (duplicate of bullet 1) 
Responsible forfor adhering to ligning/reviewing medical necessity guidelines and IRS Regulations to determine eligibility to approve or deny claims. 
Adherence to metrics? Responsible for meeting production and quality metrics. 
Compliance ? 
 
This is more of a requirement in ability (Ability to communicate professionally with leads and management team). 

Background / Experience Required 
Prior claim experience preferred, but not required 
Computer knowledge and skills, comfortable learning new systems 
Able to learn, memorize and retain information 
Basic understanding of medical / reimbursement terminology preferred, but not required 
Can adapt to a fast paced environment 
High School Diploma / GED, preferred 
Ability to work overtime and occasional weekends (Jan – Mar) required
 
Ability to communicate professionally with leads and management team 
Strong attention to detail needed to maintain accuracy while processing.
Claim Benefit Specialist As a Claim Benefit Specialist, you will enter a challenging, fast pace but rewarding position while providing amazing member experience for our customers. Ultimately, this will enable the delivery of the PayFlex Mission Statement by driving compassion, confidence, and trust while delivering one superior quality experience at a time. This role requires attention to detail to ensure we are processing the claim accurately to ensure a great member experience based on the claim form they’ve submitted for reimbursement. This journey begins as a temporary position with potential for fulltime with benefits.  Effective Communication –It is critical to be able to effectively use resources that are available and communicate clearly with your leads/supervisors on any further assistance needed to accurately process the reimbursement claim form that has been submitted by the member. Ability to maintain a professional attitude and respect for peers in the workplace. (i.e. caring, empathy, positive attitude and tone) to drive effective communication amongst your peers.  Detail Oriented – Monitors and checks work or information and plans and organizes time and resources efficiently.
Key Words: Quality Assurance, Thoroughness, Efficiency.  Decision Making / Problem Solving- making use of available tools and resources to make informed decisions while processing claims.  Work Independently- When assigned a task(s) you take ownership and don't require constant assistance or supervision to complete that task(s). Once assigned to a claims work queue be able to complete the task with sufficient details to accomplish accuracy while processing.  Training – Up to 4 weeks of robust formal classroom training will be executed. Completion of quizzes to check overall understanding and completion to continue to process claims effectively.  Reliability – Upon completion of training, a schedule of 8:00am-5:00 pm CST (with the potential of mandatory/voluntary of hours during the week.) Attendance and punctuality is a must for being successful at PayFlex-ability to work Mandatory Saturday’s as they are needed. Key Responsibilities  Accountable for accurately adjudicating claims and determining eligibility for Flexible Spending Accounts, Dependent Care Accounts and Health Reimbursement Accounts. XXXXXXXXX (what are they doing? Are they adjudicating, are they sending claims to different levels, are they making decisions on a claim to be paid or not be paid?? cy and production standards (what are they??)  Resolves difficult claims (what defines a difficult claim? Do the claims get reviewed by others? using available resources and makes decisions with minimal management intervention.  Strong attention to detail needed to maintain accuracy while processing. (duplicate of bullet 1)  Responsible for adhering to lining/reviewing medical necessity guidelines and IRS Regulations to determine eligibility to approve or deny claims.  Adherence to metrics? Responsible for meeting production and quality metrics.  Compliance ?   This is more of a requirement in ability (Ability to communicate professionally with leads and management team). Background / Experience Required  Prior claim experience preferred, but not required  Computer knowledge and skills, comfortable learning new systems  Able to learn, memorize and retain information  Basic understanding of medical / reimbursement terminology preferred, but not required  Can adapt to a fast paced environment  High School Diploma / GED, preferred  Ability to work overtime and occasional weekends (Jan – Mar) required  Ability to communicate professionally with leads and management team  Strong attention to detail needed to maintain accuracy while processing.