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Claims/Customer Care Specialist -TPA
Medical Mutual • Remote • Posted 8 days ago
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Remote • Full-time • Entry Level
Job Highlights
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The Claims/Customer Care Specialist - TPA position at Medical Mutual offers the flexibility to work from home within a 50-mile radius of an Ohio Medical Mutual office. This role involves processing healthcare claims and providing customer service to third party administration and/or ancillary product services customers. The position offers a path for career advancement through three levels, each with increasing responsibilities and skills required.
Responsibilities
- Processes routine healthcare claims while providing customer service via inbound/outbound phone calls and written communications.
- Assists with projects as directed by management.
- Processes routine to moderately complex healthcare claims and/or adjustments while providing customer service.
- Under direction of more senior staff, conducts routine claims research in response to inter/intra-departmental inquiries.
- Serves as a peer mentor/trainer for team members and initiates and provides input for process improvements.
- Processes routine to complex healthcare claims and/or adjustments while providing customer service.
- Conducts and responds to complex claims research projects in response to inter/intra-departmental inquiries and escalations.
Qualifications
Required
- Associate degree in business administration, Communications or related field or equivalent combination of training and experience.
- 1 year customer service and/or claims experience, preferably in a call center in the health insurance industry for Level I.
- 2 years' experience as a Claims/Customer Care Specialist or equivalent customer service experience in the health insurance industry for Level II.
- 3 years' experience as a Claims/Customer Care Specialist or equivalent customer service experience in the health insurance industry for Level III.
- Basic Microsoft Office Skills.
- Basic knowledge of health insurance products and medical terminology.
Preferred
- Healthcare field certification (e.g., medical terminology, certified coder/biller).
- Third Party Administration experience.
About Medical Mutual
Medical Mutual is a health insurance company based in the United States. Founded in 1934, it offers a wide range of health and life insurance products for individuals, families, and groups. Operating primarily in Ohio and surrounding states, Medical Mutual focuses on providing affordable and accessible healthcare coverage through its network of healthcare providers.
Full Job Description
The Claims/Customer Care Specialist - TPA position allows you the flexibility to work at home as long as you reside within a 50-mile radius of an Ohio Medical Mutual office.
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 1.6 million Ohioans 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.
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 and help our members achieve their best possible health and quality of life.
Applies knowledge and skills obtained through on the job training to process routine healthcare claims and respond to inquiries from third party administration and/or ancillary product services customers regarding benefits, coverage or claim status, in accordance with established performance expectations and service philosophy.
Responsibilities
Claims/Customer Care Specialist I - TPA
• Processes routine healthcare claims while providing customer service via inbound/outbound phone calls and written communications.
• Assists with projects as directed by management.
• Performs other duties as assigned.
Claims/Customer Care Specialist II - TPA
• Processes routine to moderately complex healthcare claims and/or adjustments while providing customer service via inbound/outbound phone calls and written communications.
• Under direction of more senior staff, conducts routine claims research in response to inter/intra-departmental inquiries.
• Assists with projects as directed by management.
• Performs other duties as assigned.
Sr. Claims/Customer Care Specialist - TPA
• Processes routine to complex healthcare claims and/or adjustments while providing customer service via inbound/outbound phone calls and written communications.
• Conducts and responds to complex claims research projects in response to inter/intra-departmental inquiries and escalations.
• Serves as a peer mentor/trainer for team members and initiates and provides input for process improvements.
• Assists with projects as directed by management.
• Performs other duties as assigned. Qualifications
Claims/Customer Care Specialist I - TPA
Education and Experience:
• Associate degree in business administration, Communications or related field or equivalent combination of training and experience.
• 1 year customer service and/or claims experience, preferably in a call center in the health insurance industry.
Professional Certification(s):
• Healthcare field certification a plus (e.g., medical terminology, certified coder/biller).
Technical Skills and Knowledge:
• Basic Microsoft Office Skills
• Basic knowledge of health insurance products and medical terminology.
Claims/Customer Care Specialist II - TPA
Education and Experience:
• Associate degree in business administration, Communications or related field or equivalent combination of training and experience.
• 2 years' experience as a Claims/Customer Care Specialist or equivalent customer service experience in the health insurance industry. Third Party Administration experience a plus.
Professional Certification(s):
• Healthcare field certification a plus (e.g., medical terminology, certified coder/biller).
Technical Skills and Knowledge:
• Basic MS Office skills
• Knowledge of third-party administration/ancillary products, services, policies, procedures and systems.
Sr. Claims/Customer Care Specialist - TPA
Education and Experience:
• Bachelor's degree in business administration, Communications or related field preferred, but will consider collective experience, training and education.
• 3 years' experience as a Claims/Customer Care Specialist or equivalent customer service experience in the health insurance industry. Third Party Administration experience a plus.
Professional Certification(s):
• Healthcare field certification a plus (e.g. medical terminology, certified coder/biller).
Technical Skills and Knowledge:
• Basic MS Office skills
• Thorough knowledge of third party administration/ancillary products, services, policies, procedures and systems.
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:
Excellent Benefits and Compensation:
An Investment in You:
About Medical Mutual:
We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 85 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!
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.
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 1.6 million Ohioans 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.
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 and help our members achieve their best possible health and quality of life.
Applies knowledge and skills obtained through on the job training to process routine healthcare claims and respond to inquiries from third party administration and/or ancillary product services customers regarding benefits, coverage or claim status, in accordance with established performance expectations and service philosophy.
Responsibilities
Claims/Customer Care Specialist I - TPA
• Processes routine healthcare claims while providing customer service via inbound/outbound phone calls and written communications.
• Assists with projects as directed by management.
• Performs other duties as assigned.
Claims/Customer Care Specialist II - TPA
• Processes routine to moderately complex healthcare claims and/or adjustments while providing customer service via inbound/outbound phone calls and written communications.
• Under direction of more senior staff, conducts routine claims research in response to inter/intra-departmental inquiries.
• Assists with projects as directed by management.
• Performs other duties as assigned.
Sr. Claims/Customer Care Specialist - TPA
• Processes routine to complex healthcare claims and/or adjustments while providing customer service via inbound/outbound phone calls and written communications.
• Conducts and responds to complex claims research projects in response to inter/intra-departmental inquiries and escalations.
• Serves as a peer mentor/trainer for team members and initiates and provides input for process improvements.
• Assists with projects as directed by management.
• Performs other duties as assigned. Qualifications
Claims/Customer Care Specialist I - TPA
Education and Experience:
• Associate degree in business administration, Communications or related field or equivalent combination of training and experience.
• 1 year customer service and/or claims experience, preferably in a call center in the health insurance industry.
Professional Certification(s):
• Healthcare field certification a plus (e.g., medical terminology, certified coder/biller).
Technical Skills and Knowledge:
• Basic Microsoft Office Skills
• Basic knowledge of health insurance products and medical terminology.
Claims/Customer Care Specialist II - TPA
Education and Experience:
• Associate degree in business administration, Communications or related field or equivalent combination of training and experience.
• 2 years' experience as a Claims/Customer Care Specialist or equivalent customer service experience in the health insurance industry. Third Party Administration experience a plus.
Professional Certification(s):
• Healthcare field certification a plus (e.g., medical terminology, certified coder/biller).
Technical Skills and Knowledge:
• Basic MS Office skills
• Knowledge of third-party administration/ancillary products, services, policies, procedures and systems.
Sr. Claims/Customer Care Specialist - TPA
Education and Experience:
• Bachelor's degree in business administration, Communications or related field preferred, but will consider collective experience, training and education.
• 3 years' experience as a Claims/Customer Care Specialist or equivalent customer service experience in the health insurance industry. Third Party Administration experience a plus.
Professional Certification(s):
• Healthcare field certification a plus (e.g. medical terminology, certified coder/biller).
Technical Skills and Knowledge:
• Basic MS Office skills
• Thorough knowledge of third party administration/ancillary products, services, policies, procedures and systems.
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:
- Top Workplace in Northeast Ohio. Year after year we've received this recognition!
- On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
- On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
- Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
- Business Casual attire
Excellent Benefits and Compensation:
- Competitive compensation plans
- Employee bonus program
- 401(k) with company match and an additional company contribution
- Excellent medical, dental, vision, and disability insurance
An Investment in You:
- Career development programs and classes
- Mentoring and coaching to help you advance
- Education reimbursement up to $5K per year
About Medical Mutual:
We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 85 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!
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.
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