The HT Group has partenered  with a company within the Health Insurance industry to hire a Claims Eligibility Specialist II.
This position will be a Direct Hire Remote position. Must have LVN, LPN or LSW designation.

As a Claims Eligibility Specialist II, you will play a critical role in reviewing and managing claims of varying complexity. You’ll work closely with a collaborative team, supporting the accurate and timely processing of claims while ensuring a high-quality customer experience. This is a great opportunity for someone with a strong background in claims and a desire to grow in a fast-paced, mission-driven environment.

ESSENTIAL JOB FUNCTIONS

• Investigates, maintains, and supports others in managing cases of varying complexity, including but not limited to:
• Reviews and evaluates coverage and / or liability. 
• Analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, records, or other documents) to determine eligibility claim decisions.
• Establishes appropriate Plan of Care according to Claim Handling Guidelines
• Manages short-term/limited approval claims.
• Assists with complaints/appeals.
• Conveys more complex information (coverage, decisions, outcomes, etc.) to all appropriate parties, maintaining a professional demeanor in all situations.
• Ensures claims handling is conducted in compliance with applicable statues, regulations, and other legal requirements, and that all applicable company procedures and policies are followed.
• Works closely with Team Lead(s), and can provide back up support to the Team Lead(s)
• Provides guidance and support to lower-level positions and other functional areas and other duties as assigned.
  

Qualifications

• 5+ years of related experience in claims management and review, with experience in the insurance industry and with related products a plus.
• Bachelor’s degree in LVN, LPN, LSW, Business or a related field, or equivalent years education/experience
• Possesses a high level of technical knowledge and skills related to claims management and review
• Communicates effectively, both orally and in writing, with empathy and strong listening skills
• Performs work under limited supervision.
  

*HPIND