Manages and coordinates changes for existing customers. Provides focused service fostering strong relationships with internal business partners to assure all administrative updates are loaded correctly. Heavy emphasis on the Source Renewal quoting changes. Analyzes and determines if products and services selected by clients are aligned and can be adequately supported by existing systems or operating platforms; additionally, seeks solutions and negotiates essential requirements in… Show more Manages and coordinates changes for existing customers. Provides focused service fostering strong relationships with internal business partners to assure all administrative updates are loaded correctly. Heavy emphasis on the Source Renewal quoting changes. Analyzes and determines if products and services selected by clients are aligned and can be adequately supported by existing systems or operating platforms; additionally, seeks solutions and negotiates essential requirements in support of any non-standard plan selections. Requires dynamic decision making to appropriately structure the group setups within the Meritain system to align with our vendor partners (PBM’s, Managed Care Entities, etc..), analytics vendors and provide the required structure for client billing and reporting.Consults and communicates with internal staff regarding the details associated with new business and revision activity in a timely manner and validates account structure and pricing.Completes timely and accurate set-up of complex account structure and detailed benefit plans in systems for multiple constituents in order to satisfy both internal and external deadlines for production- impacting a wide variety of products and services.Monitors and manages internal installation process and maintains case tracking to meet constituents expectations and business goals.Maintains data files for monthly group reporting, assuring PHI guidelines are being followed.Participates in testing related to enhancements/changes made in the ER/EO/GIM data files.Supports broader teams as necessary. Show less

Process and authorize payment of medical claims, ensuring accuracy and adherence toinsurance coverage.Monitor medical bills to identify errors and ensure compliance with insurance policies.Respond to medical providers' inquiries and address any complaints or discrepancies.Review medical records to determine medical necessity and process claims accordingly.Review and make determinations on appeals from members regarding claim reconsideration.

Review new insurance documents for accuracy and enter data into company software andMicrosoft Office products.Ensure correctness and completion of all policy packets and insurance ID cards for new insuredcompanies.Conduct audits for the eligibility department and collaborate with management to resolvediscrepancies.Update renewal information in the system and mail renewal documents to current insuredgroups.Operate switchboard and manage incoming faxes, directing… Show more Review new insurance documents for accuracy and enter data into company software andMicrosoft Office products.Ensure correctness and completion of all policy packets and insurance ID cards for new insuredcompanies.Conduct audits for the eligibility department and collaborate with management to resolvediscrepancies.Update renewal information in the system and mail renewal documents to current insuredgroups.Operate switchboard and manage incoming faxes, directing documents to appropriatedepartments Show less

Coordinate in-house communications with claimants, referral sources, adjusters, and physicians'offices for verification of eligibility and services.Coordinate set-up of services with DMEPOS providers and pharmacies.Review rehab orders and determine pricing for wheelchair repairs and new custom wheelchairs.Negotiate pricing with providers and maintain records of pricing agreements.Communicate with members and providers regarding project timelines.

Act as an expert in both client and caregiver relationships, leading by example.Handle scheduling of caregivers, training, and documentation reviews.Assist in recruiting and hiring procedures.Conducting meetings with prospective clients to promote and market the business, fostering relationships and driving growth