Claims Specialist - Miami, FL

Job Description

Job Description

The Claims Specialist works with and reports to the Department Manager. The position is located at 75 Valencia Ave, Coral Gables, FL 33134.

Job Essential Duties and Responsibilities: To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Minimum one year of medical claims processing experience.
• Medical, dental and vision claims adjudication.
• Utilize MWG Administrators Policy Administration System and Claims Management Software to verify eligibility and review members accounts based on the policy assigned.
• Input data into MWG Administrators Claims Management Software.
• Handle incoming mail, provider appeals, inquire, and racers. Review member correspondence and process or direct to the appropriate department.
• Maintain quality customer services by following customer service practices, responding to customer inquiries.
• Perform periodic audits on individual and group policies to verify claims have been paid correctly.
• Protect operations by keeping claims information confidential.
• Ensures legal compliance by following company policies, procedures, and guidelines.
• Identify and escalate issues to supervisors.
• Meet or exceed all performance metrics.
• Be knowledgeable and have a clear understanding of the business processes within Morgan White Group including all internal departments, insurance carriers, brokers/agents, and group contacts.
• Perform other duties as assigned by the Department Manager.