Claims Specialist I

Birdsong Hearing Benefits coordinates hearing healthcare services for employees with workers’ compensation claims. The Claims Specialist I plays a critical role in ensuring authorized hearing healthcare for injured workers while maintaining communication with clients, providers, and patients.

Responsibilities

• Obtain a complete, thorough understanding of the workers’ compensation claims administration process, fees and participants
• Adhere to customer Service Level Agreements (SLAs) by maintaining contact with clients, providers, and claimants/patients as prescribed to ensure all parties are kept informed of the process status
• Successfully prioritize the workday utilizing our task-based systems, resulting in achieving daily completion of all required tasks (ensuring SLA compliance)
• Ensure orders are properly documented in a timely manner
• Demonstrate an understanding of the workers’ compensation referral and RFA process
• Demonstrate an understanding of navigating client/claimant requirements to ensure billable item eligibility is reviewed prior to submitting requests to client
• Perform verification of all HCPC/CPT codes that will be requested. This includes not only verifying eligibility but confirming whether NCCI edits and/or a state fee schedule (SFS), is applicable
• Coordinate the completion of necessary documentation to be filed with state agencies when applicable
• Maintain a high degree of detail and accuracy throughout the claim administration process
• Cross utilize phone, email, and fax for communication to ensure efficient processing time
• Assist with phone answering and intake related duties
• Demonstrate basic to intermediate level process understanding and ability to critically think and solution for complex situations that arise
• Other duties as assigned by the manager

Skills

• HS Diploma or equivalent
• Advanced knowledge and experience with computer systems and business software programs, in particular Salesforce, Word, Excel, Outlook, Office 365 Apps and Adobe Acrobat
• Excellent grammar and written skills
• Ability to type at a minimum of 40 WPM
• Ability to travel for training and occasional on-site meetings
• Communicate clearly, professionally and in a timely manner
• Manage multiple tasks simultaneously in a proficient manner
• Ability to maintain professional client and provider relationships
• Work collaboratively with colleagues, including regularly providing direct support by completing team members' tasks for them as needed
• Understand when situational discretion must be employed in the handling and sharing of client, provider, and/or claimant information
• Self-motivated; ability to work independently
• Must have a high attention to detail
• Must be coachable and receptive to feedback
• Must be dependable and consistent
• Ability to take a proactive approach to all situations
• Driven by a focus on reaching a specific objective or accomplishing a given task
• Eagerness to adapt to new methods
• Obtain satisfaction from delivering great customer service
• Willing to try new things/operate outside of your comfort zone
• Previous workers' compensation, insurance claims management, and/or hearing healthcare industry experience is preferred
• Bilingual skills will be extremely helpful with some patients

Benefits

• Medical, dental, prescription, and vision benefits
• 24/7 virtual medical care
• Employee Assistance Program for you and your family
• 401(k) with company match
• Company-paid life insurance
• Supplemental insurance for yourself, your spouse/partner, and your children
• Short-term and long-term disability insurance
• Pre-tax Health Savings Account and Flexible Spending Accounts for Health Care or Dependent Care
• Pet Insurance
• Commuter accounts

Company Overview