Group Operations Specialist

Mô tả công việc

The Renaissance Health Services Corporation family is comprised of companies that focus on affordable health care benefits, employee benefit and claim management services, and access cards to reduce health care costs for groups and individuals. RHSC companies date back to 1957 and have offices in Indiana, Kentucky, Michigan, New Mexico, North Carolina, New York, Ohio, and Tennessee. Collectively, RHSC companies provide coverage for nearly 8 million people and in 2010 exceeded $2 billion in dental claims. www.RenaissanceFamily.com or www.RenaissanceDental.com.Operations SpecialistJob Summary:To provide customer service and handle claims processing.Principal Job Responsibilities:1. Researches benefits and claims inquiries through the claims processing system and other informational sources.2. Responds to customers, groups and provider questions through telephone contact and written communication using proper grammar, punctuation, etiquette, etc.3. Enters, modifies and adjusts claims and eligibility information in the system.4. Reviews and prepares orthodontics and complex service claims for processing.5. Makes benefit determinations using Renaissance’s processing guidelines.6. Reviews subscriber’s coverage to determine type and level of benefits as well as compares radiographs with treatment plans.7. Enters, reviews, and edits provider data.8. Maintains related departmental documents