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Product Operations Liaison
Chicago, IL
Job Description
PRODUCT OPERATIONS LIAISON
POSITION SUMMARY:
To execute Claim review and investigation of multiple claim functions, including but not limited to the management and facilitation of High Dollar claim reviews, claim processing and special claim requests.
ESSENTIAL FUNCTIONS:
POSITION SUMMARY:
To execute Claim review and investigation of multiple claim functions, including but not limited to the management and facilitation of High Dollar claim reviews, claim processing and special claim requests.
ESSENTIAL FUNCTIONS:
- Facilitate the High Dollar Claim review process by acting as the primary contact for internal and external claim teams, clients and vendors. Owns audit processes for the High Dollar Claim process for claims $20K to $30K
- Facilitates the CHS claim processes by acting as the primary contact for internal and external claim teams. This includes the Core Value claim processes coordinated through CHS.
- Executes effective resolutions on claim issues and ensures that the appropriate Allied teams are informed, handles claim escalations and sees through to completion.
- Processes fee claims for Case Management, Enhanced Case Management, HRA Pharmacy claims and various other vendor fee.
- Demonstrates strength and understanding of all workflows and business processes to execute the overall service strategy for BPO Clients.
- Fosters a sense of urgency and commitment to achieve goals resulting in the ability to influence the organization to meet and exceed customer expectations.
- Will own responsibility for and facilitate communications as stated above, handle escalations and oversee assist in various ad hoc projects as assigned.
- Perform other duties as assigned.
EDUCATION:
- Bachelor's degree or equivalent work experience
EXPERIENCE AND SKILLS:
- 1-3 years experience in an administrative or data entry role required
- Group Health Insurance/Benefits experience preferred
- Experience working with medical claims a plus
- Excellent verbal and written communication skills.
- Excellent organizational skills and attention to detail.
- Excellent time management skills with a proven ability to meet deadlines.
- Strong analytical and problem-solving skills.
- Ability to prioritize tasks and to delegate them when appropriate.
- Ability to function well in a high-paced and at times stressful environment.
- Proficient with Microsoft Office Suite or related software.
POSITION COMPETENCIES:
- Job Knowledge
- Time Management
- Accountability
- Communication
- Initiative
- Customer Focus
PHYSICAL DEMANDS:
This is a standard desk role - long periods of sitting and working on a computer are required.
WORK ENVIRONMENT:
Remote
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
1 to 3 years
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