Claims Specialist

Description

Why AGIA?

AGIA Affinity is an established but growing insurance and benefits marketing partner to some of the largest and most iconic associations and organizations in the country. Our clients include many veterans' organizations and ensuring that our servicemembers have the coverages they need when they need it is at the heart of everything we do. For 66 years we have sought to improve the lives of not only our client members but our internal members as well.

What Are The Benefits?

AGIA offers health benefits including medical, dental, and vision, 401K with 100% company match up to 3% of your annual income and an additional 50% match on the next 2% of income, a prefunded optional FSA , 100% covered Life Insurance, Accidental Death and Dismemberment Insurance, Short Term/Long Term Disability, and a $250 Wellness Benefit. Our medical plan has in-network provider coverage for mental health, reproduction, chiropractic, and massage therapy.

Time off:

We offer 10 days of vacation your first year, and each year you gain an additional day. Each year, you'll be earning more vacation time at a faster rate. Every associate gets 13 paid and closed holidays each year.

Position Summary:

The Claims Specialist is responsible for analyzing and adjudicating claims for group cancer and hospital indemnity plans in a timely and accurate manner and in strict accordance with defined carrier, state and federal requirements to ensure an excellent customer experience.

Essential Job Functions:

• Research submitted claims and records regarding eligibility and compliance with the provisions of the Certificate of Coverage to ensure accurate application of coverage benefits.
• Process low to medium complexity claims to ensure timely and accurate response to claimants in strict accordance with carrier, state, federal and internal compliance requirements.
• Generate concisely written correspondence to members, insureds and providers to request required information in a timely and accurate manner and follow-up as required.
• Monitor and review pended claims to ensure that final claim determination and follow-ups are performed in accordance with carrier, state and federal requirements.
• Support the Member Benefits Service Department with customer inquiries including handling customer emails and both outbound and inbound phone calls.
• Perform other miscellaneous functions and special projects as assigned.

Requirements

Education/Certification:
High school diploma or equivalent.

Required Experience:
One year claims analysis and adjudication experience with health claims preferred.

Required Knowledge: 

Knowledge of CPT codes, RVS codes and ICD9/10 coding and medical terminology.

Skills/Abilities:

• Basic proficiency in MS Office.
• Strong attention to detail.
• Strong alpha numeric and ten-key typing skills.
• Ability to work in a fast paced and changing environment.
• Excellent customer service skills.
• Good verbal, written and interpersonal skills.
• Good deductive reasoning, problem solving and analysis skills.

Travel:
No travel required.

Work Schedule:
Regular office schedule. No weekends. First 60 days will be in office for training. Once training is complete, will work fully remote.