Benefits Claims Support Specialist

Group Management Services is looking for an detail oriented individual with the ability to multi-task as our newest Benefits Claims Support Specialist.First and foremost, what is GMS?GMS, a Professional Employer Organization (PEO), is one of the fastest growing companies in one of the fastest growing industries in the country. We take on the burden of HR administration by providing comprehensive solutions ranging from payroll, benefits and healthcare, risk management and overall employee relations matters among other services to our clients.With the ever changing landscape of employment law, small and medium sized companies just do not have enough time to invest in the growth of their business having to worry about such issues. That is where Group Management Services comes in to play.What are some of the primary responsibilities of a Benefits Claims Support Specialist?Serve as a specialist and liaison between our member benefits services and claims services team managing outbound communication with both members and providers.Oversight for emails and letter communications to members reviewing processes established for our vendor Insource, eliminating inefficiencies, monitoring work, and answering inquiries.Call members for claims which need more information for accident details, coordination of benefits or subrogation, when no response is received.Act as a liaison between lawyers for subrogation letters to provide necessary information on the claim.Processing and responding to member and provider appeals (non-IDR and non-specialty Rx).Handling of returned EOBs and ID cards for members to resend ID cards.Responsible for the coordination of tickets to Cigna for pricing corrections and clarifications when a member or provider calls the member benefits team.Run accumulator reports and analyze them to determine reason for member overage - duplicate claims, auto adjudication error, etc.Update SBCs, MPD, and QR code documents when plan changes to be reviewed for accuracy by more senior employees.Perform all other duties as assigned.What are some of the perks and benefits that come with employment at GMS?Salary range between $45,000-$50,000 commensurate with experienceFull Medical, Dental, Vision401(k) with company matchLife and Disability benefits3 weeks of PTO in years 1-5; 5 weeks of PTO in years 6+7 paid holidaysCompany laptop providedMonthly cell phone reimbursement planFlexible scheduling and autonomy in your roleWhat are some Qualifications?Education - High School diploma (or GED Equivalence) required;Experience - 1-2 years health insurance required, TPA customer service experienced preferred as well as claims adjudication experience.Skills - Must be proficient in Microsoft Office and familiar with Excel; experience with claims adjudication software a plus. Ability to read, analyze and interpret EOBs, EPPs, SBCs, MPDs with knowledge of claims coding and billing.Why GMS?People don't necessarily buy what you do, they buy WHY you do it. GMS is passionate about small businesses having started off as one back in 1996 in Richfield, OH with only a few employees. Fast forward to today and we have over 500 employees in 25 offices across 18 states nationwide. We take pride in building and maintaining quality relationships with our customers as we help them grow their own business exponentially just as we did by allowing them the time and energy to focus solely on reinvesting in themselves.As we continue to expand ourselves here at GMS, we are looking for individuals who are willing and able to provide excellent customer service and support to their clients. We are looking for those who are passionate about the value small business brings and providing them assistance in their growth as they seek growth for themselves. We are committed to providing opportunities for upward mobility from within to those who are driven to succeed and who care about the relationships they build. Join the GMS team today, build relationships, seek growth and experience a truly family oriented workplace culture!For more information please visit our website at Group Management Services is an Equal Opportunity Employer.

Created: 2025-02-14