Claims/Customer Care Specialist-Tpa

Claims/Customer Care Specialist-TPA

This is a fully remote opportunity; Eastern Time Zones preferred.

Responsibilities

Claims/Customer Care Specialist I-TPA

• Processes routine healthcare claims while providing customer service via inbound/outbound phone calls and written communications.

• Assists with projects as directed by management.

• Performs other duties as assigned.

Claims/Customer Care Specialist II-TPA

• Processes routine to moderately complex healthcare claims and/or adjustments while providing customer service via inbound/outbound phone calls and written communications.

• Under direction of more senior staff, conducts routine claims research in response to inter/intra-departmental inquiries.

• Assists with projects as directed by management.

• Performs other duties as assigned.

Senior Claims/Customer Care Specialist-TPA

• Processes routine to complex healthcare claims and/or adjustments while providing 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.

• Serves as a peer mentor/trainer for team members and initiates and provides input for process improvements.

• Assists with projects as directed by management.

• Performs other duties as assigned.

Qualifications

Claims/Customer Care Specialist I-TPA

• Associates Degree in Business Administration, Communications or related field or equivalent combination of training and experience.

• 1 year customer service and/or claims experience, preferably in a call center in the health insurance industry.

• Healthcare field certification a plus (e.g. medical terminology, certified coder/biller).

• Basic Microsoft Office skills.

• Basic knowledge of health insurance products and medical terminology.

Claims/Customer Care Specialist II-TPA

• Associate Degree in Business Administration, Communications or related field or equivalent combination of training and experience.

• 2 years’ experience as a Claims/Customer Care Specialist or equivalent customer service experience in the health insurance industry. Third Party Administration experience a plus.

• Healthcare field certification a plus (e.g. medical terminology, certified coder/biller).

• Basic Microsoft Office skills.

• Knowledge of third party administration/ancillary products, services, policies, procedures and systems.

Senior Claims/Customer Care Specialist-TPA

• Bachelors' Degree in Business Administration, Communications or related field preferred, but will consider collective experience, training and education.

• 3 years’ experience as a Claims/Customer Care Specialist or equivalent customer service experience in the health insurance industry. Third Party Administration experience a plus.

• Healthcare field certification a plus (e.g. medical terminology, certified coder/biller).

• Basic MS Office skills.

• Thorough 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:

• 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
• Top Workplace in Northeast Ohio. Year after year we've received this recognition!
• Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
• On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
• Business Casual attire

Excellent Benefits and Compensation:

• 401(k) with company match and an additional company contribution
• Excellent medical, dental, vision, and disability insurance
• Employee bonus program
• Competitive compensation plans

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.