Employee Benefit Management Services, Inc.
  • 16-Jan-2018 to 17-Mar-2018 (MST)
  • Claims
  • Billings, MT, USA
  • Hourly
  • Full Time

Generous Benefits Available!


Job Summary:
This position constructs and implements new plan documents in the claims system. This position maintains a comprehensive understanding of the plan document(s) under their scope of responsibility.

Essential Duties and Responsibilities:
1. Plan building
1.1. Designs and implements system set up in accordance to plan document description.
1.2. Builds new groups and adjusts system per plan amendments in Claims system.
1.2.1. Documents applicable changes in related systems.
1.3. Determines benefits using ICD, CPT, HCP and Rev Codes in association with provider specialty, age, relationship, place of service and PPOs.
1.4. Updates accumulators for newly implemented groups.
2. Plan Document Language
2.1. Ensures plan language conforms to the group's intent.
2.2. Interprets and explains plan document language and plan designs for various EBMS departments.
3. Customer Service
3.1. Receives and resolves internal inquiries regarding plan document language and design.
3.2. Provides timely and thorough follow up with, internal and external customers.
3.3. Appropriately escalates difficult issues up the chain of command.
3.4. Acts as a role model in demonstrating the core values in customer service delivery.
3.5. Trains and mentors new employees as assigned.
4. Quality Assurance
4.1. Attends and participates in committee meetings and training sessions.
4.2. Performs self quality monitoring in order to develop and execute plans to meet established goals.
4.3. Provides ongoing feedback to help optimize quality performance.
4.4. Collaborates with staff and cross-departmentally to improve or streamline procedures.
4.5. Assists the Claim Department in performing plan design testing for new clients and renewing clients to assure quality output from the system.
5. This job description in no way states or implies that these are the only duties to be performed by this employee. The employee will be required to follow any other instructions and to perform any other duties requested by his/her supervisor.

Minimum Qualifications:
• High school diploma or equivalent
• Associates degree or equivalent experience preferred
• three years of Claims Examiner and/or plan building experience required
• Medical coding experience preferred
• Familiarity with GBAS system preferred.
• Working knowledge of computers and software including but not limited to Microsoft Office products
• Proficient mathematical, 10-key and typing skills
• Demonstrated organizational skills, problem-solving, analytical skills and detail oriented
• Demonstrated ability to remain neutral and maintain confidentiality
• Strong written and oral communication skills
• Demonstrated ability to work independently, prioritize workloads multi-task and manage priorities in order to meet deadlines

Physical Demands & Working Conditions:
Work is indoors in an office environment with moderate noise. Intermittent physical effort involving lifting of up to 25 pounds, walking, and stooping, kneeling, crouching, or crawling is required. A typical workday involves sitting, frequent use of a keyboard, reaching with hands and arms, and talking and hearing, approximately 70% of the time. Approximately 30% or less of the time is spent standing. Normal vision abilities required, including close vision and ability to adjust focus.

Employee Benefit Management Services, Inc.
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