Senior Benefit Review Specialist

KPH Healthcare Services • Full-time • Gouverneur, NY, US • 1w ago

Overview

Scope of Responsibilities: Works under direct supervision and follows standard procedures to accomplish assigned tasks related to the Implementation and Benefit Review Team.

Job Summary: Provides support to the Implementation Manager for all aspects of customer service, account management, quality assurance, and other administrative projects. The position will act as a lead role within Benefit Review and be a liaison to management and other organization leaders, while still performing the daily functions of a Benefit Review Specialist. These functions include, but are not limited to, assisting with the day-to-day operations of Account and Client Service Resources of ProAct and coordinating and implementing the setup/support of existing ProAct clients.

Responsibilities

Act as the Benefit Review Team leader; facilitate regular meetings with all Benefit Review Specialists.
Process and implement benefit changes and/or updates for existing ProAct clients in all appropriate systems.
Oversee and perform testing for all new ProAct clients to measure benefit accuracy.
Assist the Implementation Manager in coordinating the team’s audit strategy.
Perform quality assurance audits on a regular basis to measure client satisfaction.
Assist Account Resources with impact analysis review.
Maintain client information integrity within all appropriate systems.
Assist Customer Service Representatives in the resolution of customer service issues, requiring additional support, to ensure complete client satisfaction.
Assist Account Resources in the resolution of customer service issues, requiring additional support to ensure complete client satisfaction.
Coordinate, maintain, and manage the distribution of member mailings.
Collect and maintain various team metrics, providing regular reporting to the Implementation Manager and other leaders, as necessary.
Assist in facilitating and performing training sessions for both new and existing employees.
Provide support to the Implementation Manager and/or the Account and Client Resources, as needed, when communicating with external business partners.
Responsible for completing all mandatory and regulatory training programs.

Perform other duties as assigned.

Qualifications

Education:

Required: Minimum High School Diploma or GED
Preferred: AS Degree or Higher in Business Administration, Marketing or related field

Experience:

Required: Minimum 1year experience with the RxSense adjudication and reporting platforms
Required: 2 years experience in Customer Service
Preferred: 2 years experience with Health Care, Insurance, or related field

Compensation:

$22.00 - 24.00 per hour.

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience, and education.

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state, and federal regulations as it pertains to minimum wage requirements.

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