Position Summary:

PrimeCare Benefits Group, Inc. is seeking a full time Claims Specialist to support our Operations team. We are a team of highly motivated professionals, dedicated to providing excellent service to our clients and policyholders.

Essential Functions and Responsibilities:

Claims Specialist will be responsible for various administrative and operational duties including, but not limited to, those listed below. Additional duties will be assigned, as needed.

• process claim adjustments and appeals
• import enrollment files into claims system
• import claims files into claims system
• update incomplete claims for processing
• enter enrollments into enrollment system
• update and maintain policyholder information
• process cancelation requests from policyholders
• process premium payments from, and refunds to, policyholders
• create invoices in billing system for policyholders and clients
• prepare claims for payment and print payment reports
• communicate with policyholders regarding enrollment and payment
• communicate with Call Center regarding claims
• collaborate with other departments on various projects
• assist Operations team with project planning and execution
• assist in quality testing of claims system and various company website(s)
• identify process and workflow enhancements to improve efficiency
• attend internal planning and project meetings
• safeguard privacy and confidentiality of policyholder information

Education and Experience

• knowledge of Microsoft Office products (Outlook, Word, Excel)
• knowledge of general administrative and clerical procedures
• ability to communicate and collaborate with other departments

Key Competencies

• communication skills
• information collection and management
• planning and organizing
• accuracy
• customer service skills
• team work
• creative thinking
• confidentiality

Compensation

Salary compensation will be based on experience and skills. Claims Specialist will be a full time employee of our company and, as such, will be eligible for benefits provided for employees at similar employment levels.