Bywater Claims Examiner
Founded in 2003, Roundstone is not your typical insurance company. We’re on a mission to help employers save on healthcare benefits so they can put those savings towards bettering their businesses and taking care of their employees
Role Description
As a Bywater Claims Examiner you will review medical, dental, and vision claims to determine appropriate payment. This role requires the ability to accurately process claims in a timely manner and manage service requests. Bywater Claim Examiners are subject matter experts and are often asked to explain claim processing or review previously paid claims for accuracy. To be successful in this role, one must be flexible, able to see the big picture while paying attention to small details, and able to manage their time independently.
Key Duties & Responsibilities:
- Ability to read, understand, and communicate medical benefits according to SPD language;
- Prompt and timely processing of claims accurately according to established expectations (150 claims per day);
- Process claims in accordance with benefit contracts, plan policies, and production/quality requirements;
- Prior to claim adjudication, establish proof of loss by reviewing and understanding medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting an investigation of questionable claims;
- Request and follow-up on additional information as needed for incomplete claims, including but not limited to COB, accident investigations, eligibility, etc.;
- Familiar with and understands various fee schedules;
- May include but are not limited to: processing claims, claim system testing, over/under payments and special projects.
Desired Qualifications:
- Knowledge of TPA administrative services, policies, procedures and systems, testing of plan setup;
- 3 years experience processing Medical, Dental, Vision claims applying appropriate benefits;
- Certified in Medical Terminology I, II and ICD9/10 knowledge;
- Excellent verbal, communication, and written skills with strong organizational and research skills;
- Proficiency in Microsoft Office (Word, Excel and Access);
- Must be detail-oriented, have ability to work well under pressure, and handle multiple tasks with deadlines;
- Bilingual (English/Spanish) skills a plus.
Better Benefits:
We’re leaders in our industry, so naturally, we look out for our employees’ best interests with a robust benefits package. Roundstone employees are eligible for:
- Medical, dental and vision benefits
- Annual bonus
- Dependent care 100% match up to max allowable
- PTO beginning on Day 1
- Tuition reimbursement
- Health work/life balance
- Hybrid office schedule
- 401(k) plan with company match
- Employee Assistance Program
- On-site gym with personal trainer access
- Life insurance and short term disability insurance
More About Roundstone
Headquartered in Lakewood, Ohio, Roundstone is regularly recognized as a Northeast Ohio Top Workplace by the Plain Dealer and cleveland.com. We are especially proud to be recognized as a Top Workplace since this honor is determined by anonymous feedback from our own employees. Roundstone employees enjoy a supportive workplace where they are engaged, valued and regularly recognized for their hard work at monthly company meetings. Roundstone’s core values are evident every day and are shared with the community through the sponsorship of community events and outreach.
Our Core Values
- Live well: Be healthier and bring positive energy to all you do.
- Work smarter: Get things done, better.
- Own it: Accountability is your middle name. Be on time, do what you say, and finish what you start.
- Be intellectually curious: Always be learning. See opportunity everywhere and have a drive to know.
Culture and fit are integral to success and in an effort to achieve a better match both from a candidate's perspective and our organization, please take a minute, click on the link and take the really brief survey:
https://go.apply.ci/p/XoefKbRCMZnL
Don't meet every single requirement? Studies have shown that women and people of color are less likely to apply to jobs unless they meet every single qualification. At Roundstone Insurance we are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles.