Job Description

Heavy contact with providers, participants, their families and business managers. Contact with the Department management, Health Department, Eligibility Department, Pension Department and Contributions Department personnel. Daily contact with vendors (medical, prescription, dental and vision, etc.).

ESSENTIAL FUNCTIONS

 Provide benefits information to providers, participants and their business managers for medical, dental and vision claims.

 Handle all issues regarding the Health Plans prescription vendor; verifies benefit coverage, vacation overrides, medication authorizations by contacting client services department and by on-line updates. Also contacts various pharmacies and helps pharmacists through the authorization process.

 Handle all questions regarding the Health Plans Dental and Vision benefits.

 Assist the participants and providers with their calls regarding claims payment issues by researching the system, faxing or reissuing claims documentation. Work with claims examiners regarding any adjustments or questions about a claim that were discussed with the caller.

 As applicable, follow up with callers to explain the resolution of the issue they originally reached out to the Health Plan about.

 Review the Health Plan Summary Plan Description, medical reference books and guidelines to determine coverage of claims under the Health Plan.

 Regular, predictable, and reliable attendance is required.

 Ability to accept direction and developmental guidance from supervisor.

 Ability to work effectively with individuals at all levels.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com .

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Skills and Requirements

Excellent communication and interpersonal skills necessary to communicate effectively.

 Ability to handle difficult phone calls and be professional at all times

 Strong analytical skills

 Good math skills

 Excellent organizational skills and attention to detail

 Self-motivated

 Ability to work independently with minimal supervision null

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to HR@insightglobal.com.