Oak Street Health is looking for a Senior Claim Benefit Specialist to join our team. In this remote role, you will review and adjudicate complex, sensitive, and specialized claims according to plan guidelines. You'll serve as a subject matter expert, providing training and coaching while responding to complex issues and customer service inquiries.
What You'll Do
- Review pre-specified claims or claims exceeding specialist authority or expertise.
- Apply medical necessity guidelines, determine coverage, verify eligibility, identify discrepancies, and apply cost containment measures.
- Handle phone and written inquiries related to pre-approvals, authorizations, reconsiderations, or appeals.
- Ensure all compliance requirements are met and payments follow company practices.
- Identify and report possible claim overpayments, underpayments, and other irregularities.
- Perform claim rework calculations.
- Distribute daily work assignments to junior staff.
- Train and mentor claim benefit specialists.
- Make outbound calls to obtain required information for claims or reconsiderations.
What We're Looking For
- 18+ months of medical claim processing experience.
- Experience in a production environment.
- Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
- High School Diploma.
Nice to Have
- Self-Funding experience.
- DG system knowledge.
- Associate's degree or equivalent work experience.
Benefits & Compensation
- Compensation: $18.50 - $42.35 per hour.
- Affordable medical plan options.
- 401(k) plan with matching company contributions.
- Employee stock purchase plan.
- No-cost programs including wellness screenings, tobacco cessation, weight management, confidential counseling, and financial coaching.
- Paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, and retiree medical access.
Work Mode
This is a fully remote position.
Oak Street Health is building a world of health around every consumer, surrounded by colleagues passionate about transforming health care. We provide care that is more connected, convenient, and compassionate. Our teams reflect the communities we serve and we are committed to a workplace where every colleague feels valued and that they belong.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
