Claims Support Specialist II

The Claims Support Specialist II will gather necessary information for claim adjudication via phone, fax, or email, and review new claims for eligibility. They will create and send claimant letters, and communicate with claimants, brokers, plan administrators, or physicians to obtain information for claim triage. This role involves completing requests for medical documentation, coordinating payment for records, independently managing worklists, and completing tasks within established turnaround times. Responsibilities also include communicating effectively across multiple channels, accurately summarizing medical information, making basic claims decisions based on available information and workflows, and participating in team meetings. The specialist will support change management, foster partnerships with internal departments, and ensure job performance meets department standards for prioritization, productivity, quality, and timeliness.