Claims Benefit Specialist


Location:Omaha, NE
Job ID:46866


Lexter Aguilar


Claims Benefit Specialist needed in Omaha, NE

Integrity Staffing Solutions is currently seeking a Claims Benefit Specialist in the Omaha area. Integrity Staffing Solutions provides comprehensive professional level staffing services on a nationwide basis and has been bringing companies and professionals together almost 20 years. At Integrity Staffing Solutions, we find the best, highest paying professional level positions within the top companies in the area. Most of the positions we identify will never be found in a newspaper or online because of the exclusive relationships we have with our clients who trust Integrity Staffing Solution’s recruiting team to identify top talent to fill their critical hiring needs. Finding a top paying job at a great company is often like signing the contract of a lifetime; let us get to work for you today!   


Achieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations.  


Position Summary/Mission:

Reviews and adjudicates routine claims in accordance with claim processing guidelines.   


Fundamental Components & Physical Requirements include but are not limited to

(* denotes essential functions)


• Analyzes and approves routine claims that cannot be auto adjudicated. (*)

• Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process. (*)

• Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues.

• Routes and triages complex claims to Senior Claim Benefits Specialist. (*)

• Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements. (*)

• May facilitate training when considered topic subject matter expert. (*)

• In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor). (*)

• Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., utilizes Claim Check, reasonable and customary data, and other post-containment tools). (*)



Background/Experience Desired

• Experience in a production environment.

• Claim processing experience.


Education and Certification Requirements

High School or GED equivalent.       


Additional Information (situational competencies, skills, work location requirements, etc.)



• Ability to maintain accuracy and production standards.

• Analytical skills.

• Technical skills.

• Oral and written communication skills.

• Understanding of medical terminology.

• Attention to detail and accuracy.



Additional Information:

  • Hours: Full Time
  • Pay: $16.00
  • Employment Type: Contract
  • Limited medical and dental coverage for contractors and their families available immediately
  • Opportunities for professional growth.

Integrity Staffing Solutions is an Equal Opportunity Employer. All job offers are contingent upon the successful completion of a background check and drug screen.



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