Position Overview

The Claims Support Specialist position provides comprehensive administrative support as a part of the Client Experience.

The Claims Support Specialist has responsibilities which include phone calls from members or providers as well as providing support to departments within Zelis Enterprise.

Key Responsibilities :

• Review and process correspondence from providers, members, and payors according to standard operating procedures.
• Manage various systems and databases.
• Manage communication via email and Microsoft Teams.
• Confirms that all documentation processes adhere to Zelis standards regarding privacy, compliance, legal aspects, and HIPAA standards.
• Maintain production standards according to department guidelines.
• Performs other related responsibilities as assigned.

Professional Experience :

• 1 years of medical claim payment review.
• Adhere to established HIPAA, compliance, and security policies. · Maintain a keen awareness of and ensure strict adherence to Zelis standards concerning privacy and confidentiality.
• A background in healthcare, health insurance, healthcare compliance, medical billing, negotiations, or state and federal regulated claims.

Education :

• Bachelor’s degree or equivalent experience in a healthcare setting.
• A minimum of 2 years of experience in a medical field or healthcare environment. Familiar with the lifecycle of medical claims, including reviewing explanations of benefits / payments.

Technical Skills :

• Proficient in Microsoft products (Word, Excel, PowerPoint, and Outlook), Smartsheet, and adaptable to various industry software programs.
• Working knowledge of general office equipment.

Independence / Accountability :

• Receive comprehensive instructions for assignments and seeks guidance to determine subsequent actions.
• Ability to follow detailed instructions and carry through.
• Exhibit proficiency in pertinent job responsibilities, enabling a gradual increase in autonomy.
• Maintain a professional demeanor and strictly upholds the confidentiality of administrative matters and files.
• Demonstrate adeptness in managing and prioritizing multiple tasks.
• Thrive under pressure and consistently meet deadlines.
• Regularly review goals and objectives with the supervisor.

Problem Solving :

• Tackles complex assignments that demand sound judgment and proactive problem-solving.
• Strong organizational skills needed to prioritize responsibilities and effectively complete work
• Exhibits exceptional task management capabilities, efficiently handling multiple tasks as needed.
• Meticulous attention to detail and a focus on the impact of actions are crucial attributes.
• Recognizes deviations from experienced observations.
• Completes work in a timely fashion in accordance with departmental deadlines. Alerts leadership in advance if deadlines are unable to be achieved.

Work Environment :

• Travel requirements to (primarily) domestic destinations should not exceed 5%.
• A standard work week exists but with the understanding that additional time / effort outside of the usual parameters can / will occur based upon the overall needs of the integration, where deadlines exist and when necessary due to the needs of the integration team.
• A standard business environment exists with moderate noise levels.
• Ability to lift and move approximately thirty (30) pounds on a non-routine basis.
• Ability to sit for extended periods.

Last updated : 2024-06-10