Benefit Claims Processing Associate

Job Description

About Conduent

Conduent delivers mission-critical services and solutions on behalf of businesses and governments creating exceptional outcomes for its clients and the millions of people who count on them. Through people, process and technology, Conduent solutions and services automate workflows, improve efficiencies, reduce costs and enable revenue growth. It’s why most Fortune 100 companies and over 500 government entities depend on Conduent every day to manage their essential interactions and move their operations forward.

 

Conduent’s differentiated services and solutions improve experiences for millions of people every day, including two-thirds of all insured patients in the U.S., 10 million employees who use its HR Services, and nearly nine million people who travel through toll systems daily. Conduent’s solutions deliver exceptional outcomes for its clients including $16 billion in medical bill savings, up to 40% efficiency increase in HR operations, and up to 40% improvement in processing costs, while driving higher end-user satisfaction. Learn more at www.conduent.com.


Job Description

The Claims processing team is responsible for processing a variety of benefit transactions such as pension packages, payment elections, beneficiary changes, tax changes, flexible spending account claim reimbursements, etc. for the participants of our clients.

  • Review images of paperwork from benefits plan participants, utilizing all resources, procedures, and critical thinking skills to determine eligibility for request and submit electronic transactions according to client and client/plan specific rules and IRS regulations and guidelines
  • Must be able to work in fast paces environment with multiple transactions on a daily basis
  • Activities include:
    • Electronic document preparation and indexing into case management system.
    • Review and research document images of returned mail to determine validity of address.  Notate and flag participant's account if determination is made that address is no longer valid.
    • Determine if requested transaction meets plan eligibility rules, as well as, IRS regulations and guidelines.
    • Understand "gray areas" of IRS guidelines, effectively applying these guidelines to each case processed.
    • Review legal guardianship, conservatorship and power of attorney records if transaction is requested by a party other than the participant to determine if that party is authorized to request the specific transaction.
    • Review paperwork for completeness and accuracy, including completion of all required fields and notarization, if required, and inclusion of legal documents such as birth certificate copies.  paperwork can be 30 pages or more, especially pension packages.
    • Calculate eligible reimbursement based on available funds, requested amount, requested reimbursement, previous reimbursements and substantiated documentation
    • Review history or requests, transactions, and call notes to determine if prior transactions disqualify the request, if previously incomplete paperwork is now complete, or if other exception conditions exist.
    • Paperwork such as pension packages often require submission of multiple transactions, such as setting up beneficiary elections, direct deposit elections, as well as whether the pension will be distributed in a lump sum or periodic payment, or combination of the two.
    • Maintain and update case management system notes.

Requirements and preferences

  • High School diploma required
  • As associate's degree in Business, Healthcare, or related field preferred
  • 2+ years of experience in an analytical/claims role strongly preferred
  • Successful candidates may have experience in
    • Insurance Claims Service Representative
    • Mortgage Loan Processor
    • Enrollment Data Analyst
    • Documentation Specialist in the field of Health Care, Eligibility Determination, or a similar field
  • Experience in Defined Benefits and/or Health & Welfare Preferred (but not required)
  • Strong critical thinking and attention to detail skills required

 


Closing

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form.