Transplant Benefit Analyst/Case Management Analyst - Evernorth Health Services

Under the general direction of the Supervisor, the Benefit Specialist will support Transplant Case Managers and Medical Directors with insurance knowledge and application as related to the delivery of the Case Management Product.

Additional responsibilities include but are not limited to completing benefit reviews for currently enrolled members and also for members looking to enroll into our Transplant Case Management Program.

As a Benefit Specialist, you will review eligibility; liability, primacy, claim payment direction and benefit coverage information.

Provide on-going follow-up through periodic case file review.

Responsibilities:

Review eligibility, liability, and coverage information on new cases and on regularly scheduled follow-up; provide communication of benefit plans for cases on an as-needed basis; periodically update this information

Review and direct claim payment for cases that have a treatment plan in place, and that are being managed by the coordinators.

Consult on cases moving into management regarding treatment plan funding based on case management philosophy.

Periodically review cases during management according to guidelines.

Research and analyze insurance, claim payment and nonpayment issues and problems.

Provide insurance training for new personnel and conduct insurance in-service programs as needed.

Adheres to quality assurance standards and all case management policies and procedures, especially those related to confidentiality

Adheres to productivity and workload management goals and accurately reports

Accurately and timely assessment of provider's contract to determine coverage and benefit availability

Communicates professionally with all internal and external customers, peers, matrix partners.

Qualifications:

High School diploma or GED required.

5+ years of progressive movement within group health insurance positions preferred.

2+ years of customer service experience required.

Excellent knowledge of group health benefit plans preferred.

Good analytical, evaluation, organizational and communication skills.

Ability to clearly communicate information to case managers using case management applications.

Working knowledge of medical terminology.

Ability to work independently and make independent decisions and ability to work unsupervised on special projects.

Ability to adapt to a high volume environment and work within a fast-paced dynamic environment.

Ability to function as part of a team.

Solid time management skills

Demonstrated ability to participate on/lead projects and workflow improvement initiatives.

Ability to act as change agent to support organization's objectives.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an hourly rate of 23 - 34 USD / hourly, depending on relevant...