4 development specialist jobs found

JOB DESCRIPTION Position Summary: The Benefits Specialist will serve as a dedicated resource for employees and employers throughout the leave and disability management process. This role is responsible for managing claims across multiple programs including the Family and Medical Leave Act (FMLA), Short-Term Disability (STD), Americans with Disabilities Act (ADA) accommodations, and Return to Work (RTW) coordination. The primary purpose of the Benefits Specialist is to evaluate and manage employee leave and disability claims, review medical information, facilitate workplace accommodations, and support employees in returning to work in a safe and timely manner. Essential Duties and Responsibilities: Manages end-to-end claims across FMLA, STD, ADA, and RTW programs in accordance with federal, state, and local regulations Communicates and collaborates with employees, medical professionals, supervisors, and Human Resources to support employees through the leave and...

Job Description: Summary: The Claims Examiner resolves a wide variety of claims transactions that may include, but not limited to, entry, adjudication or adjusting simple or complex claims in accordance with Member Touchpoint Measures (MTM), Inter-Plan Scorecard, FEP Performance Incentive Plan (PIP), Corporate Policies, National Committee of Quality Assurance (NCQA) and mandated requirements. Essential Accountabilities: Level I • Handle front end transactions including but may not be limited to member eligibility, entry of claims, member & provider matching and claim processing. • Identify patterns that impact quality, claim inventory, and/or the customer experience and escalate for review. • Identify potential trends and if necessary, escalate for investigation/solution. • In accordance with established departmental procedures, corporate policies, member, group, and provider contracts and riders: o Process, enter, adjudicate and/or adjust and research claims. o...

Job Description: Summary: The Claims Examiner resolves a wide variety of claims transactions that may include, but not limited to, entry, adjudication or adjusting simple or complex claims in accordance with Member Touchpoint Measures (MTM), Inter-Plan Scorecard, FEP Performance Incentive Plan (PIP), Corporate Policies, National Committee of Quality Assurance (NCQA) and mandated requirements. Essential Accountabilities: Level I • Handle front end transactions including but may not be limited to member eligibility, entry of claims, member & provider matching and claim processing. • Identify patterns that impact quality, claim inventory, and/or the customer experience and escalate for review. • Identify potential trends and if necessary, escalate for investigation/solution. • In accordance with established departmental procedures, corporate policies, member, group, and provider contracts and riders: o Process, enter, adjudicate and/or adjust and research claims. o...

Job Description: Summary: The Claims Examiner resolves a wide variety of claims transactions that may include, but not limited to, entry, adjudication or adjusting simple or complex claims in accordance with Member Touchpoint Measures (MTM), Inter-Plan Scorecard, FEP Performance Incentive Plan (PIP), Corporate Policies, National Committee of Quality Assurance (NCQA) and mandated requirements. Essential Accountabilities: Level I •\tHandle front end transactions including but may not be limited to member eligibility, entry of claims, member & provider matching and claim processing. •\tIdentify patterns that impact quality, claim inventory, and/or the customer experience and escalate for review. •\tIdentify potential trends and if necessary, escalate for investigation/solution. •\tIn accordance with established departmental procedures, corporate policies, member, group, and provider contracts and riders: o\tProcess, enter, adjudicate and/or adjust and research claims....