Advance Your Career at Planstin 

Located in Southern Utah, Planstin is at the forefront of benefits administration and business services. We simplify health insurance for employers and individuals, emphasizing cost-effectiveness and excellent service in a complex market. As our company grows, we’re looking for talented individuals eager to progress in their careers.

About the role

We’re looking for a detail-oriented Claims Specialist to join our team. This role is a great fit for someone who understands healthcare claims, enjoys solving problems, and takes pride in helping members and healthcare providers navigate the claims and reimbursement process.

As a Claims Specialist, you’ll review and process medical, dental, and vision claims while helping ensure claims are handled accurately and reimbursements are completed in a timely manner. You’ll work closely with members, healthcare providers, and internal teams to research claim issues, resolve discrepancies, and provide clear information about claim and reimbursement requirements.

What you'll do

• Review and process medical, vision, and dental claims.
• Maintain a clear understanding of all current plans and their benefit features.
• Maintain required productivity and quality standards.
• Identify process improvement opportunities.
• Send and track medical record requests.
• Communicate with healthcare providers and members around claim and reimbursement status and requirements.
• Maintain accurate records of claims and reimbursements.
• Identify and correct discrepancies in claims.
• Send and track provider refund requests.
• Ensure timely reimbursement for services.
• Monitor claim status and follow up on outstanding claims.
• Serve as a backup for clerk tasks during employee absences.
• Answer questions and provide resources to different team members.
• Other duties as assigned.

Qualifications

• Experience in claims and/or billing
• Understanding of medical terminology
• Basic knowledge of healthcare concepts including network status, reference base pricing / UCR, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, and plan variations
• ICD-10, CPT, HCPCS, CDT knowledge
• Basic understanding of coordination of benefits
• Excellent communication skills
• Must be a team player yet able to work independently
• Attention to detail
• Ability to multi-task and prioritize
• Knowledge of appeal and subrogation is preferred

Planstin's Employee Benefits: 

• 12 paid holidays plus 3 weeks of paid time off to balance work and life. 
• Comprehensive insurance coverage including health, dental, vision, and accident plans tailored for your well-being. 
• Free membership for you and your dependents to Primestin Care Clinic.
• Invest in your future with a 401k plan backed by a solid 4% match from us. 
• Free snacks and regular lunches available onsite.