- In this role you will be helping guide and review team process workflows associated with Conlan reimbursement claims, acting as a subject matter expert or SME for team members, leadership, or the client, support Conlan case processing, and engage in research and member case reviews/escalations.
Role: - Research and process Conlan claims in accordance with established Court Order requirements, applicable policies and procedures, and Service Level Agreement (SLA) standards.
- Ensure all Member Reimbursement request letters, including incomplete requests, approvals, and denials, are reviewed for completeness, accuracy, and compliance with applicable policies and procedures.
- Collaborate with team members, management, and customers to address and resolve claim-related issues, ensuring timely communication and effective problem resolution.
- Assist the Supervisor and senior management with claim research, special projects, and additional assignments as directed, ensuring timely and accurate completion of all tasks.
- Maintain and update daily, weekly, and monthly reports to ensure accuracy, completeness, and timely reporting of operational performance, workload metrics and adherence to SLA requirements.
Requirements: - High school diploma or G.E.D.
- Minimum 2 3 years of customer service, health care claiming, and/or medical related experience.
- Experience working with organizational functions and personnel; team lead experience preferred.
- Ability to follow stringent protocols for policy operations.
- Experience working with computer software and telephone technology and skilled in the use of help desk software and/or customer relationship management tools.
- Business and analytical critical thinking skills.
- Strong communication skills, written and oral; including professional email communications.
- Ability to take on special projects as needed.
- Ability to follow oral and written directions.
- Competency with Microsoft Office Suite and other similar computer programs.
Benefits:
Our Benefits Include:
- Medical, Dental, and Vision Insurance
- 401(k) Retirement Plan
- Health Savings Account (HSA)
- Disability Insurance (Short-Term and Long-Term)
- Life and AD&D Insurance
- Paid Sick Leave (where required by applicable state or local law)
- Supplemental Insurance Plans
- Identity Theft Protection
- Pet Insurance
- Employee Wellness Programs
- Employee Assistance Program (EAP)
- Career Growth and Professional Development Opportunities
Disclaimer: Benefits eligibility, accrual rates, and usage limits may vary based on employment status, length of service, and work location. Paid Sick Leave is provided in strict accordance with applicable state and municipal mandates. Cynet Systems Inc. reserves the right to modify, amend, or terminate any benefit plans at any time in accordance with applicable laws.
About Cynet Systems
Founded in 2010 and headquartered in the Washington, DC metro area, Cynet Systems Inc. is a leading technology staffing and workforce solutions company serving Fortune 500 companies, government agencies, and enterprise organizations across the United States and Canada. We deliver agile, scalable talent solutions across IT, engineering, life sciences, clinical, and professional staffing, powered by a high-performing recruitment engine operating across North America and Asia.
As a nationally and locally certified Minority Business Enterprise (MBE), Cynet Systems is committed to helping organizations build high-performing teams while empowering professionals to grow rewarding careers. Our organization is certified to ISO 9001, ISO 14001, ISO 27001, and SOC 2 Type II standards, reflecting our commitment to quality, security, operational excellence, and customer success.