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Job Description SUMMARY: The Client Coordinator will support the Client Services Team in serving and responding to clients needs on a daily basis. Essential Duties and Responsibilities include the following. Other duties may be assigned. • Works on site with consistent attendance., • Consistent Attendance, • Data entry, • Daily Fulfillments, • Assist with Renewals, • Assist with Open Enrollments, • Discrepancy Resolving, • Process Incoming Faxes and Mail, • Assist With Outbound Calls, • Performs other duties and responsibilities as assigned by Management, • Monthly Checks and Balances Reporting, • Electronic Eligibility Processing, • Returned Mail, • Import Error Log, • Receive incoming requests for research from Account Executives and Client Managers., • Research all claim questions as requested, • Gather all necessary information for claim research purposes, • Provide timely and detailed responses to requestor(s), • Build strong relationships with Account Executives and Client Managers, • Build strong relationships with Claims Management personnel, • Manage claim research and details from beginning-to-end., • Responsible for obtaining necessary information completing all activity as required., • Make calls to providers as needed to gather or provide information as directed by Account Executives and Client Managers, • Review Summary Plan Descriptions/Documents for all benefit information as needed, • Exhibit strong technical knowledge of industry, products, and compliance requirements, including plan deductibles and dates, • Appropriately escalate issues and opportunities to Upper Management as needed., • Ensure proper handling of customer issues and concerns., • Navigate and understand BRMS claims system, • Administrative duties in support to Client Services team Knowledge, Skills, & Abilities: • Strong computer skills, including Word, Excel, and Outlook, • Excellent verbal and written communication skills, • Good analytical skills, • Positive problem-solving skills., • Ability to provide effective leadership in all aspects of position., • Must be dependable and maintain excellent attendance and punctuality., • Ability to grow with changing demands of the position and the company. Supervisory Responsibilities: This job has no supervisor responsibilities Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience: High School diploma or G.E.D; and minimum of 6 months related experience and/or training; or equivalent and any combination of education, training, and/or experience, which demonstrates ability to perform the duties described Language Skills: Ability to read, speak, and write effectively in English. Ability to interpret documents such as plan documents, memos, letters, and procedure manuals. Ability to write routine reports, meeting notes, project documentation, and correspondence. Ability to speak effectively before customers or employees of organization. Ability to effectively address or resolve customer service issues within guidelines of the position. Mathematical Skills: Ability to add and subtract, multiply and divide with 10's and 100's. Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Certificates, Licenses, Registrations: Valid, class C license in state working with no adverse driving record. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit for extended periods in front of a computer. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and use hands to finger, handle, or feel. The employee may frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. This position requires the employee to work in the office. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Company DescriptionEstablished in 1993, Benefit & Risk Management Services, Inc. (BRMS) is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs. One of the first to introduce employee benefit administration technology solutions, our services are powered by our exclusive Virtual Benefits Administration System (Vbas) a proprietary database and administration system that allows employers to save time and money by automating management of the benefit supply chain and empowering employees to self-service their benefitsEstablished in 1993, Benefit & Risk Management Services, Inc. (BRMS) is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs.\r\n\r\nOne of the first to introduce employee benefit administration technology solutions, our services are powered by our exclusive Virtual Benefits Administration System (Vbas) a proprietary database and administration system that allows employers to save time and money by automating management of the benefit supply chain and empowering employees to self-service their benefits

Job Description Summary: The Claims Examiner I is responsible for ensuring claims are coded and processed correctly and for meeting production requirements. Processes claims by performing the following duties. This Not a Remote Position Essential Duties and Responsibilities include the following. Other duties may be assigned. · Compares data on claim with internal policy and other company records to ascertain completeness and validity of claim. · Comprehensive understanding of employee benefits for medical, dental and vision plans. · Adjudicates medical claims, applies coordination of benefits as outlined in plan guidelines and works with providers to gather the necessary documents to make final payment determination on claims · Ensures all claims are coded properly. · Examines Summary Plan Document, claim adjustors' reports or similar claims/precedents to determine extent of coverage and liability. · Maintains high quality standards to avoid paying claim incorrectly. · Maintains productivity standards set by Management. · Refers most questionable claims for investigation to claim examiner II for review and processing. · Research and resolve paid and denied claims escalations from internal sources and/or TIPS ticketing system when assigned. · Works from the claims queue manager to process & releases claims for adjudication and payment within 3-5 days of receipt. · Performs other duties and responsibilities as assigned by Management. Knowledge, Skills, & Abilities: • Excellent written and verbal communication skills., • Strong analytical skills and problem-solving skills., • Must be dependable and maintain excellent attendance and punctuality, • Must be able to perform data entry operations quickly and accurately., • Ability to grow with changing demands of the position and the company., • Strong computer skills, including Word, Excel, and Outlook., • Successful candidates must have experience processing medical claims for an insurance company or third party administrator, • Must be highly proficient in ICD-10, CPT, and HCPCS codes. Supervisory Responsibilities: This job has no supervisory responsibilities. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience: Associate's degree (A. A.) or equivalent from two-year college or technical school; Must have 3-5 years employee benefits industry experience or equivalent combination of education and experience. Language Skills: Ability to read, speak, and write effectively in English. Ability to interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports, meeting notes, project documentation, and correspondence. Ability to speak effectively before customers or employees of organization. Ability to effectively address or resolve customer service issues within guidelines of the position. Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized or non-standardized situations. Certificates, Licenses, Registrations: Valid, class C license in state working with no adverse driving record. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit for extended periods in front of a computer. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and use hands to finger, handle, or feel. The employee may frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. This position requires the employee to work in the office. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Company DescriptionEstablished in 1993, Benefit & Risk Management Services, Inc. (BRMS) is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs. One of the first to introduce employee benefit administration technology solutions, our services are powered by our exclusive Virtual Benefits Administration System (Vbas) a proprietary database and administration system that allows employers to save time and money by automating management of the benefit supply chain and empowering employees to self-service their benefitsEstablished in 1993, Benefit & Risk Management Services, Inc. (BRMS) is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs.\r\n\r\nOne of the first to introduce employee benefit administration technology solutions, our services are powered by our exclusive Virtual Benefits Administration System (Vbas) a proprietary database and administration system that allows employers to save time and money by automating management of the benefit supply chain and empowering employees to self-service their benefits

Job Description SUMMARY: The Reinsurance Coordinator is responsible for monitoring and preparing stop loss data and reports for use by carriers and internal management. Essential Duties and Responsibilities include the following. Other duties may be assigned. • Claims perspective, • Deals with clients that hits the 50% stop loss or has Trigger Diagnosis, • Main contact in dealing with carriers, including Claims Analyst and nurses, • Works with all BRMS Departments including Claims, UR, Client Managers, Accounting, Customer Support, and COBRA, • Works with UR department to get more information on claims/prognosis and any underlying information to check with physician on additional information, • Works with UR department once notified of any upcoming diagnosis, notify carrier of pending concerns, • Works with Client Managers for initial enrollment forms, additional information, etc., • Receives reinsurance checks; works with accounting to release money, • Works with COBRA on premiums payment, and eligibility, • Enters information in the system regarding status and follow up on public spreadsheet, • Sales and renewals to update issues, • Complies with policy period to file claims in timely fashion, • Runs weekly claims reports after the check run to research clients for 50% stop loss or trigger diagnosis., • Requests hospital bills, police reports, as necessary for the claims filings, • Run prescription reports for claim filings, • Acts as another layer of claims auditing as part of the filing process, • Responsible for monthly reinsurance reports for accounting., • Performs other duties and responsibilities as assigned by Management. Knowledge, Skills, & Abilities: • Excellent written and verbal communication skills., • Strong analytical skills and problem-solving skills., • Must be dependable and maintain excellent attendance., • Subject-matter expert within field., • Must be able to perform data entry operations quickly and accurately., • Ability to grow with changing demands of the position and the company., • Strong computer skills, including Word, Excel, Outlook, and Claims System organization., • Must be highly proficient in ICD-9, CPT, UBO4, HCFA codes., • Must be highly organized and detail oriented. Supervisory Responsibilities: This job has no supervisory responsibilities. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience: Associate's degree (A. A.) or equivalent from two-year college or technical school; two years working claims knowledge and/or training; or equivalent combination of education and experience. Language Skills: Ability to read, speak, and write effectively in English. Ability to interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports, meeting notes, project documentation, and correspondence. Ability to speak effectively before customers or employees of organization. Ability to effectively address or resolve customer service issues within guidelines of the position. Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized or non-standardized situations. Certificates, Licenses, Registrations: Valid, class C license in state working with no adverse driving record. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit for extended periods in front of a computer. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and use hands to finger, handle, or feel. The employee may frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. This position requires the employee to work in the office. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Company DescriptionEstablished in 1993, Benefit & Risk Management Services, Inc. (BRMS) is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs. One of the first to introduce employee benefit administration technology solutions, our services are powered by our exclusive Virtual Benefits Administration System (Vbas) a proprietary database and administration system that allows employers to save time and money by automating management of the benefit supply chain and empowering employees to self-service their benefitsEstablished in 1993, Benefit & Risk Management Services, Inc. (BRMS) is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs.\r\n\r\nOne of the first to introduce employee benefit administration technology solutions, our services are powered by our exclusive Virtual Benefits Administration System (Vbas) a proprietary database and administration system that allows employers to save time and money by automating management of the benefit supply chain and empowering employees to self-service their benefits

Job Description SUMMARY: Directs and oversees a team of case managers responsible for patient care coordination. Develops and implements case management programs, including utilization review, intake or discharge planning, and managed care contracting. Evaluates patient care data to ensure that care is provided in accordance with organizational guidelines and standards. Develops clinical care pathways that enhance cost-effectiveness while providing quality care. Essential Duties and Responsibilities include the following. Other duties may be assigned. ·Works on site Folsom Office with consistent attendance. ·Reviews requests for treatment or procedures ·Conducts case reviews for appropriateness/quality of treatment, cost containment and billing accordingly by group each month. ·Tracks and reports all hours by group and patient for current Case Management patients currently in treatment ·Develops Case Management reporting and tracking of members with trigger diagnosis history currently not in treatment and develops treatment plans to save the member and group benefit dollars. ·Maintains communication between insured, medical provider, and insurance company. ·Develop strategy, goals, & objectives for each new client. ·Provides statistical case reviews and generates utilization reports ·Examine DRG pre-certification, certification of admissions, and continued stay. ·Act as a liaison between Medical and Utilization Review departments regarding medical review issues. ·Communicate with other departments and personnel to facilitate proper and adjudication of claims. ·Review medical information from various out of state facilities for medical necessity. ·Maintain medical standards for all clients. ·Communication with hospitals, physicians, and subscribers regarding certification of hospital admissions and outpatient services. ·Makes corrections to reports, format of documentation, etc - Spelling, formatting, grammar, inconsistencies in the report ·Meets with Management team about current processes and implementing new processes ·Will serve as a resource to less experienced staff. ·Develops relationships with physicians, healthcare service providers, and internal and external customers to help improve health outcomes for members. ·May access and consult with peer clinical reviewers, Medical Directors and/or delegated clinical reviewers to help ensure medically appropriate, quality, cost effective care throughout the medical management process. ·Educates the member about plan benefits and contracted physicians, facilities, and healthcare providers. Refers treatment plans/plan of care to peer clinical reviewers in accordance with established criteria/guidelines and does not issue medical necessity non-certifications. ·Maintains compliance with regulation changes affecting utilization management. ·Reviews patients’ records and evaluates patient progress. ·Documents review information on the computer. Enters billing information and/or cost containment for services. ·Responds to complaints from UR guidelines. ·Facilitates educational programs and advises physicians and other departments of regulations affecting utilization management. ·Records and reports all information within scope of authority ·Performs administrative duties; receives, logs in and files a variety of reports, client charts, client interactions and other documents. The Medical Management Director will manage and delegate, when appropriate, the following activities: ·Working with management to develop business process analyses ·Develop recommendations for appropriate solutions. ·Validate and perform quality assurance. ·Create or revise analytical approaches to reflect current priorities and circumstances. ·Develop, analyze, and implement resource, staffing, capacity, and project plans. Mobilize project teams. Manage the team with the project plan. ·Develop plans or proposals that include cost/benefit analysis, policy, financial, operational, and organizational implications. ·Report to executive management in a manner that discusses progress against the plan, barriers, risks, contingencies, and costs. ·Conduct group facilitation and individual interviews to identify functional requirements, and identify critical issues. ·Exercise discretion, tact, and judgment when working with internal and/or external departments. Knowledge, Skills, & Abilities: · Excellent communication skills, both verbally and in writing are critical. ·Knowledge of principles, practices, and current trends in nursing as well as best practices in quality assurance. ·Knowledge and application of state and federal laws, statutes, and regulations; excellent analytical skills; ability to work as part of a team and be self-directed; and intermediate knowledge of Word and Excel. ·Experience in project consulting, analysis, and management. ·Communication qualifications include demonstrated verbal and written communication skills and ability to present information effectively, tailor presentations to a wide variety of audiences (including executive management), present complex concepts, and recommendations clearly for management decision-making purposes. ·Ability to comprehend, interprets, and applies BRMS policies; ability to coordinate a team for effective results; ability to continually adjust in a dynamic environment; and ability to work as a member of a team. Supervisory Responsibilities: Will directly supervise employees assigned to the Medical Management Department. Will be responsible for all supervisory duties including time & attendance, coaching, disciplinary actions, and performance appraisal. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience: Bachelor’s in nursing National Medical Case Management Certification RN License 1-3 years supervisory experience Language Skills: Ability to read, speaks, and writes effectively in English. Ability to interpret documents such as safety rules, memos, letters, and procedure manuals. Ability to draft routine reports and correspondence. Ability to speak effectively before customers or employees of organization. Ability to effectively address or resolve customer service issues within guidelines of the position. Mathematical Skills: Ability to add and subtract, multiply, and divide with 10's and 100's. Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Certificates, Licenses, Registrations: Current California RN License: REQUIRED National Medical Case Management Certification: REQUIRED Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit for extended periods in front of a computer. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and use hands to finger, handle, or feel. The employee may frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. This position requires the employee to work in the office. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Company DescriptionEstablished in 1993, Benefit & Risk Management Services, Inc. (BRMS) is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs. One of the first to introduce employee benefit administration technology solutions, our services are powered by our exclusive Virtual Benefits Administration System (Vbas) a proprietary database and administration system that allows employers to save time and money by automating management of the benefit supply chain and empowering employees to self-service their benefitsEstablished in 1993, Benefit & Risk Management Services, Inc. (BRMS) is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs.\r\n\r\nOne of the first to introduce employee benefit administration technology solutions, our services are powered by our exclusive Virtual Benefits Administration System (Vbas) a proprietary database and administration system that allows employers to save time and money by automating management of the benefit supply chain and empowering employees to self-service their benefits

Job Description Summary: The Reporting Coordinator is responsible for the timely and accurate management and distribution of reports across the organization. The Reporting Coordinator will collaborate with and support the Client Management Team. Essential Duties and Responsibilities include the following. Other duties may be assigned. · Gather, organize, and manage data to create comprehensive reports · Ensure data accuracy, integrity, and completeness before report generation · Maintain reporting databases and systems, ensuring data is up-to-date and accessible · Prepare daily, weekly, monthly, quarterly, and annual reports in a timely manner. · Distribute reports to Client Management Team, ensuring that all relevant parties receive the necessary information. · Ensure that reports adhere to organization standards, policies, and compliance regulation · Performs other duties and responsibilities as assigned by Management Knowledge, Skills, & Abilities: · Strong computer skills, including Word, Excel, and Outlook · Excellent verbal and written communication skills · Good analytical skills · Positive problem-solving skills. · Must be dependable and maintain excellent attendance and punctuality. · Ability to grow with changing demands of the position and the company. Supervisory Responsibilities: This job has no supervisor responsibilities Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience: High School diploma or G.E.D; and minimum of 6 months related experience and/or training; or equivalent and any combination of education, training, and/or experience, which demonstrates ability to perform the duties described Language Skills: Ability to read, speak, and write effectively in English. Ability to interpret documents such as plan documents, memos, letters, and procedure manuals. Ability to write routine reports, meeting notes, project documentation, and correspondence. Ability to speak effectively before customers or employees of organization. Ability to effectively address or resolve customer service issues within guidelines of the position. Mathematical Skills: Ability to add and subtract, multiply and divide with 10's and 100's. Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit for extended periods in front of a computer. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and use hands to finger, handle, or feel. The employee may frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. This position requires the employee to work in the office. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Company DescriptionEstablished in 1993, Benefit & Risk Management Services, Inc. (BRMS) is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs. One of the first to introduce employee benefit administration technology solutions, our services are powered by our exclusive Virtual Benefits Administration System (Vbas) a proprietary database and administration system that allows employers to save time and money by automating management of the benefit supply chain and empowering employees to self-service their benefitsEstablished in 1993, Benefit & Risk Management Services, Inc. (BRMS) is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs.\r\n\r\nOne of the first to introduce employee benefit administration technology solutions, our services are powered by our exclusive Virtual Benefits Administration System (Vbas) a proprietary database and administration system that allows employers to save time and money by automating management of the benefit supply chain and empowering employees to self-service their benefits

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The Project Coordinator will work closely with project managers, superintendents, and project directors to reconcile job budgets, timely invoice our clients, accurately capture past and future costs, and maintain project documentation. Update estimated completion dates and other relevant project fin

The Project/Service Coordinator may work independently or may support Project Managers, Operations Managers or Support Specialists on assignments to specific client projects. Monitor and report project status to Project Managers, Directors, Account Managers and other stakeholders as required. Projec

Oversee multiple projects at a time to ensure project deadlines and quality standards are met. We are currently hiring a Project Coordinator to help manage our fast-paced environment, create a consistent positive customer experience for our clients, as well as drive productivity for their respective