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Position Summary:

Beacon Hill is currently seeking a highly motivated and detail-oriented Customer Benefits Payment Representative who can operate in a dynamic and fast-paced environment, where processing claim information with speed, accuracy, and efficiency is crucial. If you are someone who thrives in a challenging environment and is passionate about providing world-class service, we want to hear from you.

This is a hybrid role with 1 to 2 in office days per month.

This department is dedicated to issuing timely and accurate benefit payments to customers and partners. Responsibilities include payment processing, data entry, records management, fraud prevention, and conducting loss or eligibility investigations. We prioritize effective, customer-centric communication with internal and external stakeholders, clients, and partners. Additionally, we ensure that all payments are adjudicated in compliance with regulatory requirements and applicable laws, leveraging legal, medical, and investigative resources when necessary. Our commitment to maintaining accurate payment records enhances the customer experience, quality review/audit process, and safeguards the company in the event of litigation and regulatory investigations. We make critical risk assessments on behalf of the company and our clients and uphold the highest ethical standards in our payment practices.

Responsibilities:

- Investigate claims using problem-solving skills to determine the most effective approach.

- Keep all interested parties informed of the claim's status throughout the investigation process.

- Evaluate investigation results and authorize payments, providing clear explanations for payment decisions or claim denials.

- Ensure all necessary information and documents in the claim file are complete, accurate, and included.

- Handle a high volume of claims while meeting established turnaround performance guarantees.

- Assist with unit telephone calls, providing information on claim status, policy provisions, and exclusions.

Requirements:

- Knowledge of benefits claim processing.

- Exceptional attention to detail.

- Strong analytical skills.

- Good judgment and decision-making abilities.

- Excellent written and verbal communication skills.

- Strong organizational skills.

- Positive and compassionate attitude.

- Demonstrated ability to achieve results in both individual and team settings.

- Willingness to learn and adapt to new and changing technologies.

- A strong desire to provide world-class customer service.

- Proficiency with Microsoft Word and Excel.

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