BeneSys, Inc. · 14 hours ago
Specialty Claims Analyst (Troy, MI)
United States
Full-time
Remote
Entry Level
$22/hr - $24/hr
2+ years expBeneSys, Inc. is a company focused on providing excellent service to its members, and they are seeking a Specialty Claims Analyst. The role involves processing various claims, providing support for health card users, and assisting with customer service to ensure timely and accurate claim payments.
IT Management
Responsibilities
Process Flex claims in the appropriate amount of time to ensure that member receives payment in a timely manner according to the rules of the plan
Coordinate with Eligibility by informing them of payouts of SUB and Disability benefits to update disability credit hours
Work with the Local Halls to determine benefits for weekly SUB payments
Prepare and send Disability and SUB Reports to the Local Halls on a weekly basis
Determine benefits for multiple groups to process claims correctly, and retrieve documentation required by each group for payments to go out; outcome is either the issuing of a check or sending letters of rejection with proper appeal procedures
Work with Pension to coordinate retirement dates, to avoid overlapping payments of both Pension and Disability simultaneously
Document Disability and SUB dates to avoid overpayments; request refunds from members when overpayments are made
Run checks on assigned days weekly, for SUB, Disability, Flex and Death Benefits, advise Operations of these check runs, and coordinate with accounting on the release of checks
Process stops payments, voids and refunds for all benefit types
Provide back-up for Customer Service and Eligibility; take calls in assigned queue for SUB, Disability, Flex and Death Claims
Research payments according to plan rules to respond to members requests for payment of claim; call back members with result. Ensure the member that claim was processed correctly, and the maximum benefit was received
Process death applications and gather information needed for different life insurance carriers for processing of death benefits
Maintain claims processing quality standards of at least 98%
Maintain claims turnaround times as defined by Specialty Claims Management based on type of claim assigned (claim TAT varies based on SUB, MRA, disability or death)
Support Plan Manager/Associates as needed
Regular and predictable attendance is an essential function of this job
Qualification
Required
Skilled in medical claims processing and knowledge of medical terminology
Two (2) years of experience in a related field
Good reasoning and phone skills
Proficient in Microsoft office
High School diploma or GED equivalent
Ability to read and interpret the plan rules as outlined in the SPD (Summary Plan Description), user manuals and department rules & procedures
Ability to communicate with members, union officials and co-workers the plan rules and procedures to process & issue Disability and SUB payments
Ability to calculate hours and SUB Credits to properly process claims for payment
Ability to determine tax amounts on payments
Ability to calculate and determine eligibility & benefits available according to multiple plan rules to process claims for payment
Preferred
Prior claims experience
Benefits
12 paid holidays
Paid Time Off (PTO)
3 days paid bereavement
Up to 20 days paid jury leave
Medical, dental, and vision insurance, with option for dependent coverage
Company-paid basic life, short-term disability, long-term disability, and AD&D insurance
401k with employer match
Tuition reimbursement program
Career development opportunities
Referral bonus for all successful full-time referrals
Annual opportunities for increases
Company
BeneSys, Inc.
BeneSys is a team of dedicated Taft-Hartley Trust Fund Specialists. BeneSys understands the nuances of Taft-Hartley benefit plans.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
Tenex Capital Management
2018-10-05Private Equity
2014-04-01Acquired
Leadership Team
Edward Wolyniec
CEO
Recent News
2025-08-29
Company data provided by crunchbase