Claims Specialist

The P&A Claims Specialist is responsible for performing complex claim adjudication duties related to Flex administration such as Section 125, 129, 132, 105(h) plans, etc. to maximize quality, quantity and total customer/client satisfaction.

Key Responsibilities

• Process claims in a timely manner.
• Review and perform all claim adjustment requests.
• Research all claim reversal requests to determine approval or denial.
• Debit card disputes – handle all fraudulent/disputed transaction requests by participants.
• Coordinate responses for routine phone inquiries and written correspondence related to claim processing issues.
• Process manual adverse determination letters to notify participants of need for additional information, or to afford them the right to appeal, per plan rules.
• Adjudicate transactions that fail auto review & make the determination if additional information is required to approve the transaction. Process manual adverse determination letters to notify participants of need for additional information, or to afford them the right to appeal, per plan rules.