Emblem Health
Claims Communications Manager-Remote (Finance)
• Responsible for managing all aspects of the Member Explanation of Benefits (EOBs) and Provider Remittance content,
process, requirements, workflows, testing, across all lines of business across the Enterprise.
• Ensure EOBs and Remittances adhere to all State, Federal regulations.
• Participate in developing test scenarios for EOBs/Remittance and review testing output. Understand claim mapping from
Facets to EOB/Remittance output.
• Act as liaison between business and IT for all issues related to EOBs/Remittances.
• Collaborate with print vendor(s) Relationship Mgrs. to ensure EOB/Remittance output complies with required regulations.
Duties and Reponsibilities:
Education, Training, Licenses, Certifications:
• Bachelor's Degree, preferably in a business-related discipline
Relevant Work Experience, Knowledge, Skills, and Abilities:
• 5 - 8+ years of relevant, professional work experience.
• 3 - 5+ years of customer service/member communications experience in a health insurance environment.
• Staff and/or process management experience, preferably in an Operations or Customer Service function.
• Proven track record of successfully managing multiple diverse/conflicting tasks/priorities.
• Excellent organizational, prioritization, and time management skills.
• Extensive knowledge of medical and hospital claims.
• Effective communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences.
• Ability to interpret information and to present concepts in a concise, accurate, and thorough manner.
• Strong analytical and deductive evaluation skills to anticipate and resolve potential EOB/EOP discrepancies.
• Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.).
Additional Information