Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Under general supervision, receives and reviews incoming clinical and related documentation from various sources and prepares and assigns clinical files for nurse review. Investigates and processes claims and/or issues and performs administrative functions in support of utilization management and effective daily operations of the department.

Responsibilities

• Receives correspondence from various sources such as providers, members, and internal departments, and determines appropriate recipient, action and priority following departmental guidelines. Prepares and assigns clinical files, ascertains information is correct, and directs to the appropriate nurse reviewer or area.

• Investigates, processes, and responds to routine to moderately complex claim issues/problems in support of utilization management programs. Reviews and completes pended (exception/flagged) claims or triages as needed.

• Processes responses to phone/ fax inquiries from providers, members, and internal departments regarding claim status information. Manages departmental email for pended claim related issues by resolving within scope of authority or tiering to appropriate nurse reviewer.

• Performs administrative support functions including creating and maintaining files, data entry, indexes documents, receives, distributes and purges mail, generates correspondence/reports, etc.

• Performs other duties as assigned.

Qualifications

Education & Experience

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

• 3 years clinical operations support experience in health insurance or equivalent office experience supporting Nurses and Physicians in a healthcare environment.

Technical Skills & Knowledge

• Knowledge of medical terminology, health insurance claims processing, and utilization review processes.

• Knowledge of HIPAA (Health Insurance Portability and Accountability Act) and Protected Health Information (PHI) regulations.

• Intermediate Microsoft Office (Word, Excel, Outlook) skills. Proficiency with document management systems (e.g. OnBase).

• Solid data entry skills.

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:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.

• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.

• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.

• Discounts at many places in and around town, just for being a Medical Mutual team member.

• The opportunity to earn cash rewards for shopping with our customers.

• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.

• 401(k) with company match up to 4% and an additional company contribution.

• Health Savings Account with a company matching contribution.

• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.

• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.

• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.

• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.

• Mentoring and coaching to help you advance in your career.

• Tuition reimbursement up to $5,250 per year, the IRS maximum.

• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.

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.

Title: Clinical Operations Support Specialist

Location: Ohio

Requisition ID: 2400445