Location: Ridgeland, MS
Company: Benefit Administration Services
Claims Adjudicator to provide superb customer service and claims management to members and medical providers. SUMMARY : Responsible for processing claims for multiple groups for medical, dental, and vision benefits. Communicates with plan sponsors regarding claims as well as the employees or providers on questions that may arise.
ESSENTIAL DUTIES & RESPONSIBILITIES Processes medical, dental, and vision benefits for multiple groups. Send claims for repricing if needed Answers questions regarding coverage and claims procedures for group sponsors, employees, and providers. Ensures compliance with all federal programs such as HIPAA and COBRA Timely response to all client/employee inquiries
and complaints to ensure quick, equitable and courteous resolution. Provide forms and other claims related materials upon request to clients/employees. Assist in various claims research requests to assist in developing and preparing reports, letters and spreadsheets.
Process checks for claims and distribute per company policy. QUALIFICATIONS- EXPERIENCE & EDUCATION Required (Minimum) Qualifications: High school diploma or equivalent Three (3) years of benefits experience processing claims on Eldorado (ECI) system Highly developed sense of integrity and commitment to customer satisfaction Ability to communicate clearly and professionally, both verbally and in writing Ability to seek positive
resolution to complaints Strong analytical abilities and critical thinking capabilities Need basic knowledge of relevant laws and regulations applicable to benefit plans Must possess " team player" mentality Proficient in all Microsoft Office software Need basic knowledge of relevant laws and regulations applicable to COBRA, HIPAA, and the Affordable Care Act.
Benefit Administration Services is an Equal Opportunity Employer and Prohibits Discrimination and Harassment of Any Kind: Bas is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment.
All employment decisions at Bas are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, interaction (including pregnancy), age, physical, mental or sensory disability, HIV Status, interactionual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.
Bas will not tolerate discrimination or harassment based on any of these characteristics. Bas encourages applicants of all ages
" by design" programming systems. They receive business needs from management, solicit product and enhancement requirements from end users, and possess the ability to convert the requests from both parties into one workable solution that is then presented to technology and staff.
To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Develops technical solutions to business problems. Defines business and technical requirements
based on the business problems presented. Performs requirement-gathering sessions to gather information from stakeholders. Converts business requirements into functional requirements.
Designs flowcharts and graphs that would visually represent the process workflow for major projects. Outlines workflow tasks for both a user's and a developer's understanding of a project's scope. Develops customized business strategies that are aligned with corporate objectives. Gathers, analyzes, and projects requirements. Strives to have an in-depth understanding of our business logic and company products. Maintains the alignment of technology and our company with business strategies. Performs other duties
as assigned by the Quality Assurance Supervisor and the Special Markets Project Manager.
EXPERIENCE AND EDUCATION REQUIREMENTS: Bachelor's degree or five years of company experience is required. The preferred candidate would possess Azure Dev Ops experience, Scrum/Agile experience, experience using Visio and an understanding of user stories, and cloud experience, but not required. Must be proficient in computer skills and have strong knowledge of Microsoft Outlook, Windows, Excel, and Word. Must possess time management, organizational, problem solving, and customer service skills. Must be able to work well under pressure with multiple priorities and meet deadlines.
Must be able to multitask while maintaining attention to details. Must be resourceful and a self motivated, team centered candidate. WORKING ENVIRONMENT: Must be able to perform in a very high paced environment and professionally handle interruptions. Must have the ability to work under minimal supervision. Must be able to prioritize projects, work multiple projects simultaneously, and meet project deadlines. Must possess excellent problem-solving skills and have keen attention to details. Must demonstrate strong written and verbal communication, interpersonal, and relationship building skills.
Must be able to handle stressful situations appropriately. Must maintain confidentiality and privacy in every aspect of the job. JOB ESSENTIAL REQUIREMENTS: The following are job functions that an employee must be capable of performing with or without reasonable accommodation. Must be able to read, write, and speak English; Spanish is a plus. Must have basic typing skills Must be able to work as scheduled. Must possess sight and hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of the position as stated above can be fully met.
Must be able to bend, stretch, reach, and sit or stand at a desk during 85% of the workday. Must be able to lift, stoop, and carry small equipment items and supplies, possibly weighing up to 20lbs.
Claims Adjudicator to provide superb customer service and claims management to members and medical providers. SUMMARY : Responsible for processing claims for multiple groups for medical, dental, and vision benefits. Communicates with plan sponsors regarding claims as well as the employees or providers on questions that may arise.
ESSENTIAL DUTIES & RESPONSIBILITIES Processes medical, dental, and vision benefits for multiple groups. Send claims for repricing if needed Answers questions regarding coverage and claims procedures for group sponsors, employees, and providers. Ensures compliance with all federal programs such as HIPAA and COBRA Timely response to all client/employee inquiries
and complaints to ensure quick, equitable and courteous resolution. Provide forms and other claims related materials upon request to clients/employees. Assist in various claims research requests to assist in developing and preparing reports, letters and spreadsheets.
Process checks for claims and distribute per company policy. QUALIFICATIONS- EXPERIENCE & EDUCATION Required (Minimum) Qualifications: High school diploma or equivalent Two years of benefits experience processing claims Highly developed sense of integrity and commitment to customer satisfaction Ability to communicate clearly and professionally, both verbally and in writing Ability to seek positive resolution to complaints
Strong analytical abilities and critical thinking capabilities Need basic knowledge of relevant laws and regulations applicable to benefit plans Must possess " team player" mentality Proficient in all Microsoft Office software Need basic knowledge of relevant laws and regulations applicable to COBRA, HIPAA, and the Affordable Care Act.
Benefit Administration Services is an Equal Opportunity Employer and Prohibits Discrimination and Harassment of Any Kind: Bas is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions at Bas are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, interaction (including pregnancy), age, physical, mental or sensory disability, HIV Status, interactionual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.
Bas will not tolerate discrimination or harassment based on any of these characteristics.
Bas encourages applicants of all ages
and documentation skills. Must be capable of working well with others. Must be able to perform all functions independently with minimal supervision in a reasonable amount of time. Must be able to evaluate work orders and projects and prioritize as necessary.
Ability to effectively prioritize and execute tasks in a high-pressure environment. DESIRED KNOWLEDGE AND SKILLS One or more years of similar or related experience in supporting business applications environments within a financial institution environment. Prefer experience with Jack Henry technologies, specifically Xperience and core. Able to execute and manage multiple projects within required timelines and expectations. Knowledge
and understanding of financial institution operation and business processes including technology solutions used in financial institution operations. Knowledge of systems analysis tools, data extraction, database queries and updates, and report writing tools.
Familiarity with problem analysis and problem-solving capabilities to establish adequate solutions to operating problems. Ability to work within a team atmosphere and develop positive working relationships. Microsoft Office GENERAL PURPOSE OF THE JOB Provides business application support for core banking system and other mission critical business applications. Supports application configuration, documentation, patching, and update
management of critical business applications to ensure optimal application performance and overall business continuity.
Act as a vendor liaison to ensure problems are successfully resolved in a timely manner. Reviews, analyzes, and evaluates business systems and end user needs to ensure appropriate strategic alignment. Provides direct customer support for business applications to bank team members. Works with various business units to solve business problems by utilizing business applications and internal processes. ESSENTIAL DUTIES AND RESPONSIBILITIES INCLUDE BUT ARE NOT LIMITED TO: Primary liaison with vendors to review, coordinate and implement new application releases and patches to include but not limited to Jack Henry core systems and ancillary products utilized to conduct the day to operations of the bank.
Follows a formal change management and documentation process for all changes made to systems. Participates in semi-annual business continuity testing to ensure availability of applications in case of system failure or natural disaster. Provides internal customer service to end users and business leaders to ensure deliverables exceed expectations and properly align with strategic initiatives. Assists with Vendor Due Diligence research and documentation when new solutions or products are explored to improve internal business processes.
Actively maintains help desk tickets, provides thorough documentation for problem resolution of tickets, and escalates tickets to higher tier level if resolution cannot be found. Assists in implementing custom software configurations. Confers with IT staff, users, and management to establish baseline requirements for new systems or modifications as needed. Assists with the development of training materials and procedures, and/or trains users in the proper use of business systems and applications.
Provides on-site and remote software support to end-users as needed. Follows and maintains knowledge of company policies and procedures. Any other duties that may be appropriate to achieve the objectives of both the department and organization. The Peoples Bank prohibits discrimination, harassment and retaliation as described in this section. The Peoples Bank will extend equal employment and advancement opportunities to all qualified individuals regardless of their race, color, religion, age (40 and over), interaction, gender, interactionual orientation, gender identity, pregnancy, disability, national origin, ethnic background, genetic information (including of a family member), military service, and/or citizenship, or any other classification protected by applicable local, state or federal law.
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