Processes routine to complex claims and adjustments and responds to written or phone inquiries from third party administration and/or ancillary product customers regarding benefits, coverage or claim status. Assists with mentoring of team members, triages escalated issues and assists team members with problem resolution.
- Processes healthcare claims and adjustments from low to high complexity.
- Mentors team members.
- Provides customer service via inbound/outbound phone calls and written communications.
- Conducts and responds to complex claims research projects in response to inter/intra-departmental inquiries and escalations.
- Participates in cross departmental meetings and projects.
- Assists Supervisor with oversight and management of inventory.
- Performs other duties as assigned.
- Bachelors' Degree in Business Administration, Communications or related field preferred, but will consider collective experience, training and education.
- 1-5 years' experience as a Claims/Customer Care Specialist or equivalent customer service experience in the health insurance industry. Third Party Administration experience a plus.
- Demonstrated leadership experience with the ability to motivate staff in a high volume production environment.
- Healthcare field certification a plus (e.g. medical terminology, certified coder/biller).
- Basic MS Office skills.
- In depth knowledge of third party administration/ancillary products, services, policies, procedures and systems.
Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:
A Great Place to Work:
- Top Workplace in Northeast Ohio. Year after year we've received this recognition!
- On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
- On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
- Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
- Business Casual attire
Excellent Benefits and Compensation:
- Competitive compensation plans
- Employee bonus program
- 401(k) with company match and an additional company contribution
- Excellent medical, dental, vision, and disability insurance
An Investment in You:
- Career development programs and classes
- Mentoring and coaching to help you advance
- Education reimbursement up to $5K per year
About Medical Mutual:
We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 85 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!
At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
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