Health and Benefits Claims Specialist

As H&B Claims Specialist, you will work to manage and monitor client’s claims submissions and claims pre-approvals. You will be in day to day communication liaison with Consultants, Clients, Client Members, Insurers, and Third Party Administrators

Role

• Conduct regular clients visits to collect and review claims and discuss any issues related to claims.
• Gathers and reviews loss information and prepares claim status reports. 
• Responds to and advocates on claims, coverage and eligibility questions from clients 
• Collects, reviews and records rejections and settlements 
• Acts as a liaison between carriers and clients, addressing service issues and monitoring for trends. 
• Develops and fosters positive relationships with clients and carriers
• Acts as a referral point and mentor for the team
• Identify areas of for improvement in claims processes leading to efficiencies

Requirements 

• Bachelor’s degree of any discipline preferably medicine / Pharmacy 
• Computer literacy
• Working knowledge of Excel, MS Project, MS Word
• Claims system experience preferred
• Knowledge of the Market Service Organizations (MSOs) such as adjusters, accountants and other experts likely to be appointed by carriers.
• Minimum 2 years experience of insurance claims handling or advocacy.
• Knowledge of specific claims area.

Application Process

• Stage 1: Online application and recruiter review  
• Stage 2 Live video interviews with hiring managers 
• Stage 3: Offer and onboarding 

WTW is an equal opportunity employer