Claims Resolution Specialist

Claims Resolution Specialist

Job Details

Job Location

iLIFE Main - Milwaukee, WI

Description

Job Purpose : The Claims Resolution Specialist is responsible for verifying, resolving, and entering various documents accurately by the required deadlines. This position is responsible for making sure iLIFE is compliant with all contractual and regulatory requirements.

Essential Job Functions :

1. Provide courteous and professional service in any inquiries via email, in person, and by phone to co-workers, managers, vendors, participants, ICA, and state programs within a timely manner.

2. Review, analyze, problem solve, and trouble shoot invoice payment inquires in a timely manner.

3. Report each pay period, monthly, and quarterly numbers to management for program audit to include invoice discrepancies, problems, and communications with customers and IC's.

4. Meet invoice production measurements to include manual daily entries for paperwork as needed.

5. Work daily on overpayment letters and processing adjustments.

6. Maintain current understanding of credentialing requirements to streamline vendor set up.

7. Communicate trends and process improvements to management to help develop efficiencies within areas.

8. Handle transit ticket process as required.

9. Ability and desire to cross-train; learn the work of other departmental staff in an effort to provide an effective back up when needed.

10. Possess the desire to learn and grow with the job, enhancing responsibility and skill set to a higher level.

Qualifications

Required Technical Skills, Experience, Education, and Credentials :

1. Associate's Degree in business or a related field or a High School Diploma/GED and a combination of training and experience which will provide the necessary knowledge and skills to successfully execute the essential functions

2. Demonstrated experience handling high volume processing experience.

3. Moderate knowledge of PC software and ability to learn new software

4. Ability to direct the work of volunteer or temporaries as needed.

5. Ability and desire to cross-train; learn the work of other departmental staff in an effort to provide an effective back up when needed.

6. Maintain a high energy level that is focused on completing departmental and agency goals in a professional and timely manner.

7. Possess the desire to learn and grow with the job, enhancing responsibility and skill to a higher level.

Work Environment and Physical Requirements

The work environment and physical demands described here are representative of those that an employee may experience or must do to successfully perform the essential functions of the job:

1. Typical hours are Monday through Friday first shift however additional time and effort beyond a normal workweek may be required to accomplish company and individual objectives and to provide a high level of service to our members.

2. Work environment is high paced and may be stressful at times.

3. Most of the work will be performed in an office environment utilizing phones, computers, copier/scanner and other office equipment

This is a general outline of the essential functions of this position and shall not be construed as an all-inclusive description of all work requirements and responsibilities that may be inherent in this position. The employee may be required to perform other job-related duties as requested by the designated work leader(s). All requirements are subject to change over time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

CFI is an Equal Opportunity/Affirmative Action Employer and promotes a Drug Free Work Environment