Modivcare is hiring a Claims Specialist II

Modivcare is seeking a Claims Specialist II to join our team. In this role, you will provide exceptional customer service by reviewing, processing, and managing claims submitted by drivers. Your focus will be on ensuring accuracy and completeness of documentation while adhering to departmental policies.

What You'll Do

• Review incoming claims and related documentation to ensure accuracy and completeness.
• Address inquiries or concerns from drivers related to claim status, payment, and discrepancies.
• Enter claim information and relevant details into the claims processing system.
• Review company policies to determine coverage and assess claim validity.
• Apply established guidelines and policies to determine claim eligibility and process claims accordingly.
• Obtain missing information by using standard scripts or form letters.
• Collaborate with drivers when applicable to gather additional information or clarify claim details.
• Maintain productivity and adhere to departmental deadlines, policies, and procedures in handling claims.
• Report suspected fraudulent claims to the Fraud, Waste, and Abuse (FWA) department.
• Assist in claims review to ensure compliance and identify potential fraud or abuse.
• Participate in other projects or duties as assigned.
• Organize and maintain departmental deadlines, policies, and procedures.
• Collaborate with other departments to resolve inquiries and concerns.
• Provide exceptional customer service via phone.

What We're Looking For

• High School Diploma required.
• One (1) plus years of experience in a data or claim processing role, or an equivalent combination of education and/or experience.
• Strong attention to detail and proficient data entry skills for accurate claims processing.
• Working knowledge of Microsoft applications (Word, Excel, and Outlook).
• Analytical mindset with the ability to interpret claim data and follow established guidelines.
• Excellent customer service skills.
• Strong verbal and written communication skills to interact with a superior customer-focused demeanor.
• Problem-solving abilities to address claim issues and resolve discrepancies.
• Ability to work independently and as a member of a team.
• Ability to accurately type 35 words per minute and use 10-key.

Technical Stack

• Microsoft Word
• Microsoft Excel
• Microsoft Outlook

Benefits & Compensation

• Compensation: $17/hour
• Medical, Dental, and Vision insurance
• Employer Paid Basic Life Insurance and AD&D
• Voluntary Life Insurance (Employee/Spouse/Child)
• Health Care and Dependent Care Flexible Spending Accounts
• Pre-Tax and Post-Tax Commuter and Parking Benefits
• 401(k) Retirement Savings Plan with Company Match
• Paid Time Off
• Paid Parental Leave
• Short-Term and Long-Term Disability
• Tuition Reimbursement
• Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)

Modivcare is an Equal Opportunity Employer. EEO is The Law. We consider all applicants for employment without regard to race, color, religion, sex, sexual orientation, national origin, age, handicap or disability, or status as a Vietnam-era or special disabled veteran in accordance with federal law.