Specialist

• Analyze and process claims in a productive environment through our TLC claim system, SIR, plan specs and

specimen policy

• Appropriately interpret a variety of plan provisions and process claims accordingly, calculating claim payments and

overpayments

• Review claims for receipt of all needed documentation and make outbound calls to providers for additional

information

• Collaborate with our Claim Support Specialists, Customer Call Center and Care Coordinators to provide a seamless

        claims experience

• Abide by department guidelines and appropriately follow up on necessary tasks to process claims

• Meet quality review standards of processed claims

• Meet performance standards for financial accuracy, processing accuracy and claim timeliness

Respond to insured inquiries regarding specific claim details via telephone conversations and/or written

correspondence

• Gather and analyze information skillfully to identify and resolve problems in a timely manner