Claims Support Representative

This is a fully remote position, open to applicants in Florida.

📋 Description

• Engage professionally with various business units to collect and analyze data necessary for the proper adjudication of claims and documentation within claims files.

• Evaluate requests related to Power of Attorney, Guardianship, and Authorizations to Release Information.

• Support the Claims team in obtaining medical documentation to effectively determine long-term care eligibility.

• Review submitted documents to ensure they are complete and accurate.

• Assist Claims Management in allocating work tasks to associates within our workflow.

• Respond to customer inquiries in a professional and timely manner.

• Ensure that service calls are handled promptly, efficiently, and with expertise.

• Follow up on outstanding documentation through additional correspondence, reviewing fax failures, and checking returned mail.

• Reach out to providers and customers to acquire accurate contact information.

• Stay updated on federal, state, and insurance regulations and requirements.

• Maintain a comprehensive understanding of all company services relevant to the business segment.

• Demonstrate proficiency in company claims and administrative software systems, as well as Microsoft applications.

• Uphold client and company quality and production standards.

• Stay informed about applicable company policies and procedures.

• Operate in compliance with company regulations concerning HIPAA, fraud, confidentiality, and private health information.

• Additional duties may be assigned.

⛳️ Requirements

• A High School diploma is required, with prior experience in the Long-Term Care insurance sector and/or administrative roles preferred, though not mandatory.

• Capability to read, analyze, and interpret complex documents.

• Ability to respond effectively to sensitive inquiries and complaints.

• Skills to write clear policies and procedures.

• Proficiency in delivering effective presentations.

• Exceptional verbal and written communication skills.

• Strong customer service abilities; commitment to work standards; decision-making skills; communication proficiency; interpersonal skills; integrity/honesty; and adaptability/flexibility.

• Must possess the ability to perform basic mathematical operations such as addition, subtraction, multiplication, and division across all units of measure.

• Ability to calculate figures and amounts, including discounts, interest, commissions, proportions, percentages, area, circumference, and volume.

• Ability to apply common sense understanding to execute instructions provided in written, oral, or diagrammatic form.

• Capability to address problems involving several concrete variables in standardized situations.

🏝️ Benefits

• Reasonable accommodations may be provided to assist individuals with disabilities in performing essential job functions.

• PTO Tier

• Non-exempt