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Claims Specialist

Springfield, MA

Posted: 01/10/2023 Pay Rate: $20/hr, based on experience

Job Description

  • Process claims in accordance with the plan document in a timely and accurate manner
  • Perform detailed analysis of medical treatment submitted for payment
  • Investigate and administer the terms of coverage
  • Prepare High Dollar files for review from carriers
  • Communicate with Policyholders, Claimants, Providers and Agents as required
  • Manage Individual mailbox according to company standard
  • Respond to email inquiries from providers and claimants
  • Respond to customer service inquiry forms within 2 business days
  • Meet and/or exceed productivity standard of: Minimum of 225 production points per day, Goal of 275 production points, Stretch of 400 production points per day
  • Meet and/or exceed accuracy standard of: Procedural 98%, Financial 99%
  • Support the customer service team when required by answering incoming calls and provide issue resolution
  • Maintain a working knowledge of State/Federal insurance regulations and mandates
  • Maintain product/system knowledge

Job Requirements

  • Ability to learn the basics of insurance and the products serviced at the company
  • Ability to learn the LuminX claim system
  • Ability to learn and understand the claim adjudication process
  • Demonstrates a solid understanding of COB, Subrogation and HIPAA Privacy
  • Demonstrates the ability to comprehend and interpret documents, such as training manuals, correspondence, brochures, policies etc.

Additional Information


Meet Your Recruiter

Tanner Soos
Staffing Manager

Tanner joined the Pascoe team in July 2022 and is very excited for this new experience! He attends the Isenberg School of Management at the University of Massachusetts Amherst. In his free time, he loves to golf, run, and play music. He has been singing in a band for almost seven years and enjoys being on stage and meeting new people. Tanner still plays lacrosse and hockey, loves the Boston Bruins and  always finds time to watch every game.

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