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Claim Benefit Specialist
Ref No.: 18-13299
Location: Omaha, Nebraska
Start Date / End Date: 11/26/2018 to 11/25/2019
Duration:0-12 month(s)

Description/Comment: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.

Additional Job Details: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.