Healthcare Specialist

2 weeks ago

Makati, Philippines Strategic Staffing Solutions Full time

Overview

Position : Healthcare Insurance Analyst

Work Set-Up : Onsite

Schedule : Night Shift (EST)

Responsibilities
  • Conduct comprehensive audits on group members to evaluate their health insurance coverage, encompassing medical, dental, vision, and hearing benefits.
  • Integrate modified membership information into the database to ensure it is up to date and accurate.
  • Handle inquiries from groups regarding member healthcare coverage in a comprehensive manner.
  • Confirm the eligibility of members and ensure that their coverage is within the appropriate time frame of the group.
  • Verify that members in the internal systems align with the members listed in the group files.
  • Investigate any discrepancies between coverage in the system and actual coverage of a member and determine the appropriate course of action.
  • Confirm the eligibility of members by verifying that their provider/primary care physician (PCP) information matches that in the system. Verify that the PCP selected by the member is eligible to be a provider by checking the system using their National Provider Identifier (NPI).
Top skills
  • Strong MS Office skills, particularly MS Excel, Access, Outlook, and Teams.
  • Strong communication skills – ability to write emails to a group of professionals, grammatically correct without errors.
  • Time management – able to handle audits, respond to group emails, team emails, etc.
  • Healthcare Insurance experience REQUIRED.
Qualifications
  • High school diploma or GED required. Bachelor’s degree in related field preferred.
  • High knowledge of MS Office, specifically MS Excel, MS SharePoint, MS Access and MS Teams.
  • High knowledge in data entry and reporting.
  • At least 2 years of relevant experience in healthcare insurance.
  • At least 2 years of experience in data analysis and analytical skills.

Strategic Staffing Solutions (S3) is a woman-owned global IT consulting and business services corporation headquartered in Detroit, MI with industry expertise in financial services, IT, energy and utilities, oil and gas, healthcare and insurance, telecommunications, and retail distribution. Founded in 1990, carries zero debt with locations throughout the US, Americas, Europe, and Asia.

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