What are the responsibilities and job description for the Life & Disability Benefits Specialist I position at Medical Mutual?
Note: This position requires five days per week on-site in the Brooklyn Ohio office.
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
Job Summary
Prepares and establishes new claims files from incoming mail. Verifies eligibility and benefit amounts being claimed and inputs claim data into the system. Responds to routine customer inquiries (via email or phone) or directs them to the appropriate department. Manages coordination of incoming and outgoing mail. Dispatches reports to groups that have submitted claims.
Responsibilities
Education and Experience:
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
Job Summary
Prepares and establishes new claims files from incoming mail. Verifies eligibility and benefit amounts being claimed and inputs claim data into the system. Responds to routine customer inquiries (via email or phone) or directs them to the appropriate department. Manages coordination of incoming and outgoing mail. Dispatches reports to groups that have submitted claims.
Responsibilities
- Opens, sorts and distributes mail, checks and files; maintains filing system. Determines the status of a new or continuing claim. Sets up claims files in claims system for all life and disability benefit types and distributes work accordingly.
- New Claims:
- Determines eligibility using CMS claims and leave administration systems.
- Sets up all claims in the system with correct benefit schedules, plans, taxation, and interest indicators.
- Sets up ACH information.
- Prepares a new Short-Term Disability claim file with all relevant documents for the assigned analyst.
- Completes claims system setup, document scanning, and worksheets.
- Continuing Claims:
- Identifies appropriate analyst and claim type.
- For life claim: scans documents into claims system and retains original documents.
- For Short Term Disability: collects the file and delivers to appropriate analyst.
- Responsible for managing the department's email inbox, fax, and incoming customer phone calls from the toll-free number. Responds to routine customer phone inquiries and emails in the shared department mail queue and routes them to the appropriate individual or area within the organization.
- Responsible for department administrative duties that may include departmental scanning projects, ordering supplies and purchase requests, check handling, preparing and mailing monthly, quarterly and annual statements.
- Performs other duties as assigned.
Education and Experience:
- Bachelors’ Degree in Business or Healthcare Administration or related field preferred. Equivalent education and experience directly related to the role may substitute for a degree.
- 1 to 2 years' experience with disability and/or life claims processing/customer service, preferably in group insurance, or equivalent relevant experience.
- Basic Microsoft Office, claims processing/billing/customer service applications, and document storage/workflow (OnBase) application skills.
- Knowledge of standard office procedures and equipment (multi-function copier/printer/scanner, conference phone, etc.).
- Basic knowledge of life and disability products/services.
- Basic knowledge of regulations and Company policies related to leaves of absence, disability, workers compensation, etc.
- Basic knowledge of Family and Medical Leave Act (FMLA) and Americans with Disabilities Act (ADA).