Trades Medical Benefit Specialist

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

📋 Description

• Oversee daily operations and escalations for designated medical benefit copay programs.

• Act as an advocate for stakeholders by offering comprehensive information on medical claim issues.

• Function as the primary contact for provider medical claim escalations.

• Perform both verbal and written outreach to provider locations, patients, and other stakeholders.

• Deliver customer service as a representative of the service team.

• Analyze circumstances, interpret data, draw conclusions, and decide on suitable actions.

• Assist pharmaceutical representatives and their sites with medical benefit programs.

• Examine comprehensive medical claim scenarios and identify resolutions.

• Uphold ethical standards regarding confidentiality and privacy.

• Keep records in accordance with pertinent standards and program regulations.

• Assess programs and propose new tools, forms, and procedures.

• Engage in program meetings and initiatives for improvement.

• Collaborate with vendors and internal stakeholders to document, escalate, and resolve issues.

• Participate in continuing education to stay informed about programs and related areas.

⛳️ Requirements

• An Associate or Bachelor’s degree is preferred; alternatively, a minimum of 5 years of experience in customer service or medical claims.

• A strong grasp of medical claims processing, rejection troubleshooting, reversals/adjustments, and provider medical claims workflows is advantageous.

• Excellent verbal and written communication skills.

• Proficiency in Microsoft products, particularly MS Excel, and the ability to review data sets.

• Capable of serving as a liaison between client-facing teams and technology and operational delivery teams.

• Ability to manage and prioritize multiple competing demands effectively.

• Strong customer service and collaboration capabilities.

• Experience in managing vendors, contractors, and subcontractors.

• Demonstrated problem-solving and organizational skills in handling escalations.

• Logical, efficient, detail-oriented, and committed to follow-through.

• Ability to multitask within a dynamic, fast-paced environment.

• Strong interpersonal skills with the capacity to work independently and as part of a team.

• Typing speed of at least 35 words per minute with 97% accuracy is preferred.

• Successful completion of a background check and, depending on the role, a drug screening.

🏝️ Benefits

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing to premium costs.

• Telehealth and Employee Assistance Program (EAP) services available.

• Company matching on Health Savings Account contributions.

• Complimentary Basic Life and AD&D coverage equivalent to annual earnings, with a minimum of $50,000 and a maximum of $300,000.

• Company-funded Short-Term Disability coverage, with an option to purchase Long-Term Disability.

• 401(k) Retirement Savings Plan featuring a 100% match on the first 5% contributed, with immediate vesting.

• Paid Time Off (PTO) and Sick Leave provisions.

• Nine paid holidays plus two floating holidays offered.

• Opportunities for career advancement and personal as well as professional development.

• A challenging, stimulating work environment that fosters new ideas.

• An inclusive workplace with a mission-driven culture.

• Minimal travel flexibility preferred.