Individual Market CIR Claims Processor III

• Review, research, and resolve claims in accordance with contracts and policies through the utilization of reference materials and on-line tools.

• Identify, research, and resolve coordination of benefits, subrogation and general inquiry issues and communicate the results.

• May complete claim adjustments, reversals and/or refunds.

• Act as the team technical subject matter expert including training and auditing trainee claims and providing appropriate feedback and technical support.

• Keep reference materials updated.

• Develop and maintain excellent relationships with both internal and external customers through the use of both written and verbal communications. This will include making outbound calls as well as receiving inbound calls.

• Prepare formal history reviews.

• Consistently meet cycle time/productivity goals that are aligned with corporate objectives.

• Maintain confidentiality of all documents/files.

• Other duties or special projects as assigned.

• Translate data into information acceptable to the claims processing system including follow up on pended claims.

• Apply commitment to quality by doing things right the first time in order to avoid defects from reaching customers or requiring internal re-work.

• High School diploma or GED (Required).

• One (1) year of claims processing experience or customer service experience (Required).

• Understanding of Out-of-area programs.

• In-team focused audit experience.

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.

• Voluntary benefit offerings, including pet insurance for paw parents.

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• Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.

• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.

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• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.

• Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

• Commuter perks make your trip to work less impactful on the environment and your wallet.

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• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.

• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.

• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.

• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.