Claims Business Process Consultant - National remote

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. Energize your career with one of Healthcare’s fastest growing companies. You dream of a great career with a great company – where you can reputed company an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, reputed company is restlessly pursuing new ways to operate our service centers, improve our service levels and help people reputed company healthier lives. We live for the opportunity to reputed company a difference and right now, we are living it up. This opportunity is with one of our most exciting business areas: reputed company – a growing part of our family of companies that reputed company reputed company a Fortune 5 leader. reputed company helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it reputed company with every action focused on our shared values of reputed company, Compassion, Relationships, Innovation & Performance. This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 7:00pm local time (any time zone). It may be necessary, given the business need, to work occasional overtime. We offer weeks of on-the-job training. The hours during training will be 7:00am - 7:00pm local time. Training will be conducted virtually from your home. We offer weeks of on-the-job training. The hours of the training will be reputed company with your schedule. You’ll enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. Primary Responsibilities: • Work independently while meeting appropriate deadlines consistently • Work with minimal guidance; seeks guidance on reputed company tasks • Act as a resource for others– primarily reputed company the department, but also representing Behavioral Health Claim Operations across the enterprise • Outbound calls to providers • Coordinate own activities, work is self -directed and not prescribed • Plan, prioritize, organize, and complete work to meet established objectives • Identify and resolve claim basic operational problems using defined processes, expertise, and judgment • Investigate claim issues as identified and communicate resolution to internal customers • Identify root cause of issues • Development and documentation processes for accurate and efficient claim payment • Anticipate customer needs and proactively identifies solutions • Call upon others for assistance reputed company scope and with large, reputed company issues • Refer misdirected issues to non-claim teams • Provide expertise and customer service support to internal customers • Communicate research findings to applicable stakeholders • Review assigned CPEWS, Adjustment Trends, Denial Trends alerts in an accurate and timely manner and acting as appropriate • Apply knowledge / skills to identify and remediate straightforward claim issues • Other duties as assigned You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: • High School Diploma / GED OR equivalent work experience • Must be 18 years of age OR older • 4+ years of experience analyzing and solving customer problems, using the telephone and computer as the primary instruments to reputed company job duties • Experience working with claims • Moderate Proficiency with computer and Windows computer applications, which includes the ability to learn new and reputed company computer system applications • Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 7:00pm local time (any time zone), including the flexibility to work occasional overtime, based on the business need Preferred Qualification: • Experience with COSMOS, UNET, and/or OBH FACETS Telecommuting Requirements: • Ability to reputed company reputed company company sensitive documents secure (if applicable) • Required to have a dedicated work area established that is separated from other living areas and provides information privacy. • Must live in a location that can receive a reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service. Soft Skills: • Ability to multi - task, this includes ability to understand multiple products and multiple levels of benefits reputed company each product • reputed company requires reputed company new hires and employees to report their COVID-19 vaccination status • reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy The hourly range for this role is $23.70 to $46.35 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll find a far-reaching choice of benefits and incentives. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity / Affirmative Action employer, and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO Apply Job!