Trades Medical Benefit Specialist

Valeris, Inc.; Raleigh (NC); On-site; USD 52,000 - 75,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

401(k) with company match

Paid time off and holidays

EAP services

HSA- and FSA-eligible options

Job summary

Valeris, Inc. is seeking a Medical Claims Specialist to handle provider offices using Valeris' medical benefit copay programs. You will troubleshoot claims, investigate status, and coordinate with external vendors to resolve escalations while delivering exceptional service.

The role requires experience in medical claims workflows, strong communication, and the ability to manage multiple escalations in a fast-paced environment. A degree is preferred, with healthcare experience a plus.

Qualifications

• Associate or Bachelor’s degree preferred; or 5+ years of customer service/medical claim experience.
• Strong understanding of medical claims processing, rejections, reversals and provider workflows.
• Excellent verbal and written communication skills with stakeholders.

Responsibilities

• Manages day-to-day activities and escalations of multiple medical benefit copay programs.
• Acts as advocate delivering detailed information for various medical claim scenarios.
• Serves as focal point for provider medical claim escalations and issues.
• Outreaches to provider sites, patients and stakeholders with supported programs.
• Maintains records in accordance with applicable standards and regulations.

Skills

Customer service

Medical claims knowledge

Verbal & written communication

Vendor management

Multi-tasking

Attention to detail

Education

Associate or Bachelor’s degree preferred

5+ years of customer service/medical claim experience

Tools

MS Excel

Job description

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana. To learn more about Valeris, please visit www.valeris.com.Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Valeris, Valeris revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need.Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products.Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients.The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana.To learn more about Valeris, please visit www.valeris.com.The Medical Claims Specialist is responsible for working directly with provider offices utilizing Valeris' medical benefit copay programs that need assistance for a variety of reasons including, but not limited to inquiries on how to submit a medical claim, troubleshoot issues, investigate claim status, or investigate/confirm payment receipt. The Medical Claim Specialist will also work directly with our outside vendors who are responsible for stages of the claim journey to troubleshoot escalations and resolve concerns of the providers.ResponsibilitiesManages the day-to-day activities and escalations of multiple medical benefit copay programs as assignedAssists all stakeholders by acting as an advocate delivering detailed information for various medical claim situationsServes as focal point for provider medical claim escalationsConduct outreach, verbal and written, to provider sites, patients and other stakeholders associated with supported programsProvides unparalleled customer service while serving as a service representativeConsistently exercises discretion to analyze, interpret, make conclusions and decide what actions to take for each situationSupport pharmaceutical reps with their sites as needed as it relates to their medical benefit programComplete understanding of end-to-end medical claim processes to investigate scenarios and determine a resolutionMaintains a high level of ethical conduct regarding confidentiality and privacyMaintains records in accordance with applicable standards and regulations to the programs/promotionsEvaluates programs/promotions to recommend the development of new tools, forms, and proceduresParticipates in program team meetings and improvement/enhancement initiatives both current and futureCollaborates with external vendors and internal stakeholders as needed to properly document, escalate, and resolve issuesParticipates in continuing education activities to remain knowledgeable in all programs/promotions and other related areasQualificationsAssociate or Bachelor’s degree preferred; or a minimum of 5 years of customer service/medical claim experienceStrong understanding of medical claims processing, rejection troubleshooting, reversals / adjustments, and provider medical claims workflows a plusAbility to provide exceptionally articulate verbal and written communicationProficient with Microsoft products including MS Excel skills with the ability to review data sets to conclude outcomeDirectly supporting and liaising between the client facing teams and technology & operational delivery teamsAbility to manage and prioritize workload based on competing demandsCustomer Service – ability to collaborate with users to articulate requests, issues and resolution on timeExperience managing vendors, contractors, sub-contractorsProven problem-solving abilities and strong organizational skills to successfully manage various types of escalationsLogical and efficient with attention to detail and committed follow through in communication with all stakeholdersWilling to work in a dynamic, fast paced environment and have the ability to multi-task with multiple escalationsStrong interpersonal skills, ability to work both independently and as part of a teamPhysical Demands & Work EnvironmentWhile performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy.Although very minimal, flexibility to travel as needed is preferred.This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.Why Work for Valeris?We’re committed to supporting the well-being and success of our team members. As part of our organization, full-time employees can expect:Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costsAdditional health support, including telehealth and Employee Assistance Program (EAP) servicesCompany match on Health Savings Account contributionsFree Basic Life and AD&D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vestingPaid Time Off (PTO) and Sick Leave to support work-life balanceTeam members receive nine paid holidays plus two floating holidaysOpportunities for advancement in a company that supports personal and professional growthA challenging, stimulating work environment that encourages new ideasWork for a company that values diversity and makes deliberate efforts to create an inclusive workplaceA mission-driven, inclusive culture where your work makes a meaningful impactAny offer of employment is contingent upon the successful completion of a background check and, depending on the position, a drug screen in accordance with company standards. Please note that this job description is not intended to be an exhaustive list of all duties, responsibilities, or activities associated with the position. Responsibilities and tasks may be modified at any time, with or without notice.Our Commitment to Equal OpportunityAt Valeris, we don’t just accept difference – we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community. Valeris is proud to be an equal opportunity employer.