Claims Review Specialist

Join Our Team as a Claims Review Specialist at Amwins Self-Funded, LLC!

Are you ready to make a meaningful impact in the dynamic world of insurance? Join Amwins Self-Funded, LLC., as a Claims Review Specialist. This is an in-office position, that offers the flexibility to work from home up to 2 days a week after completing training.

Why Choose Amwins?

At Amwins, we value our team members and offer a range of benefits to enhance your work experience:

• Flexibility: Enjoy a hybrid work environment with flexible scheduling options.
• Comprehensive Benefits: Access a competitive benefits package from day one, including generous Paid Time Off (PTO) and paid holidays.
• Continual Learning: Thrive in a collaborative, education-focused work environment.
• Annual Bonus Program: Earn incentives through our performance-based bonus program, designed to reward you for achieving key goals and contributing to the company's success.

Learn more about us at amwins.com/benefits.

Responsibilities:

• Learn Stealth’s Business Model: Understand Amwins Self-Funded business model and the products we support under the guidance of the Claims Manager and Lead Claims Auditor.
• Effective Correspondence: Correspond accurately and timely with carriers, administrators, clients, and brokers using approved form letters and emails, with all correspondence copied to the Claims Lead.
• Claim Reports Management: Manage monthly claim reports for the administration of the assigned book of business, ensuring forwarding to the appropriate carrier and following up on missing reports.
• Reimbursement Request Review: Review submitted reimbursement requests for completeness and request any missing information.
• Eligibility Documentation Approval: Obtain approval from the Claims Lead on eligibility documentation noting time-off exceeding twelve (12) weeks before submitting a claim reimbursement request.
• Claim Submission and Tracking: Record and submit reimbursement requests to the appropriate carrier within authorized dollar authority, tracking and following up on outstanding payments.
• Reimbursement Issuance: Review and issue reimbursements, notifying designated contacts accurately and in a timely manner.
• Claim Tracking Logs: Maintain internal claim tracking logs to ensure accurate records.
• Year-End Account Closure: Manage the settlement of all reimbursement requests at the end of the plan year to properly close the client’s account.
• Adaptability and Team Collaboration: Handle other duties and projects as assigned, showcasing adaptability and strong collaboration skills.

Qualifications

• Education and Experience: A college degree or equivalent work experience is strongly preferred.
• Tech Proficiency: Proficiency with Microsoft Office products (Word, Excel, Outlook, and Teams) is preferred.
• Critical Thinking: The ability to critically think and problem-solve.
• Confidentiality: Ability to maintain strict confidentiality.
• Organizational Skills: Ability to multitask, adjust to changing priorities, and effectively manage time to meet deadlines.
• Communication Skills: Effective written and verbal communication skills with both internal and external parties.
• Attention to Detail and Urgency: A sense of urgency and attention to detail are necessities.
• Eager to Learn: Eagerness to learn Stealth’s business model is a necessity.

The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.