Claims Benefit & Disability Analyst I

**Medical Mutual employees must submit their applications through MySource.

Note: This role requires you to work 5 days per week on-site in our Brooklyn, Ohio office. Seeking applicants that reside within a 50-mile radius of the Brooklyn, Ohio office.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Prepares and establishes new claims files from incoming mail. Verifies eligibility and benefit amounts being claimed and inputs claim data into the system. Responds to routine customer inquiries (via email or phone) or directs them to the appropriate department. Manages coordination of incoming and outgoing mail. Dispatches reports to groups that have submitted claims.

Responsibilities:

• Opens, sorts and distributes mail, checks and files; maintains filing system. Determines the status of a new or continuing claim. Sets up claims files in claims system for all life and disability benefit types and distributes work accordingly.
• New Claims:
• Determines eligibility using CMS claims and leave administration systems.
• Sets up all claims in the system with correct benefit schedules, plans, taxation, and interest indicators.
• Sets up ACH information.
• Prepares a new Short-Term Disability claim file with all relevant documents for the assigned analyst.
• Completes claims system setup, document scanning, and worksheets.
• Continuing Claims:
• Identifies appropriate analyst and claim type.
• For life claim: scans documents into claims system and retains original documents.
• For Short Term Disability: collects the file and delivers to appropriate analyst.
• Responsible for managing the department’s email inbox, fax, and incoming customer phone calls from the toll-free number. Responds to routine customer phone inquiries and emails in the shared department mail queue and routes them to the appropriate individual or area within the organization.
• Responsible for department administrative duties that may include departmental scanning projects, ordering supplies and purchase requests, check handling, preparing and mailing monthly, quarterly and annual statements.
• Performs other duties as assigned.

Qualifications:

education and experience:

• Bachelors’ Degree in Business or Healthcare Administration or related field preferred. Equivalent education and experience directly related to the role may substitute for a degree.
• 1 to 2 years experience with disability and/or life claims processing/customer service, preferably in group insurance, or equivalent relevant experience.

Technical Skills and Knowledge:

• Basic Microsoft Office, claims processing/billing/customer service applications, and document storage/workflow (OnBase) Application skills.
• Knowledge of standard office procedures and equipment (multi-function copier/printer/scanner, conference phone, etc.).
• Basic knowledge of life and disability products/services.
• Basic knowledge of regulations and Company policies related to leaves of absence, disability, workers compensation, etc.
• Basic knowledge of Family and Medical Leave Act (FMLA) and Americans with Disabilities Act (ADA).

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That’s why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance – insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.