Claims Specialist II

Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you!

Modivcare is looking for an experienced Claims Specialist to join our team! This position is responsible for providing customer service for the inbound claims phone line. This includes reviewing, processing and managing claims submitted by drivers including members, checking for accuracy and completion of documentation and attachments.

This role...

• Reviews incoming claims and related documentation to ensure accuracy and completeness. 

• Addresses inquiries or concerns from drivers related to claim status, payment, and discrepancies. 

• Enters claim information and relevant details into the claims processing system. 

• Reviews company policies to determine coverage and assess validity of claim. 

• Applies established guidelines and policies to determine claim eligibility and process claims accordingly. 

• Obtains missing information by using standard scripts or form letters. 

• Collaborates with drivers when applicable to gather additional information or clarify claim details. 

• Maintains productivity and adheres to departmental deadlines, policies, and procedures. 

• Reports suspected fraudulent claims to Fraud, Waste, and Abuse (FWA) department. 

• May assist in claims review to ensure compliance and/or fraudulent/abuse. 

• Organizes and maintains departmental deadlines, policies, and procedures. 

• Collaborates with other departments to resolve inquiries and concerns.  

• Provides exceptional customer service via phone. 

• Participate in other projects or duties as assigned. 

We are interested in speaking with candidates with the following...

• High School Diploma required.

• One (1) plus years of experience in a data or claim processing role.

• Or 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 services 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 the team.

• Ability to accurately type 35 words per minute and use of 10-key.

Pay Range: $14.23 - 19.21/Hourly

Modivcare’s positions are posted and open for applications for a minimum of 5 days. Positions may be posted for a maximum of 45 days dependent on the type of role, the number of roles, and the number of applications received.  We encourage our prospective candidates to submit their application(s) expediently so as not to miss out on our opportunities. We frequently post new opportunities and encourage prospective candidates to check back often for new postings. 

We value our team members and realize the importance of benefits for you and your family.

Modivcare offers a comprehensive benefits package to include the following:

• 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 - click here for more information
• Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
• 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. If you need assistance, please reach out to us at [email protected]