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Offering one of the largest medical and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care. We serve our members with products they value and a personalized customer experience, sustained by a nimble and efficient organization.

Performs routine administrative workflow tasks that support functions of Clinical Operations. Engages and educates members and providers about GEHA benefits and programs. Identifies cases for internal and external Clinical programs.

SKILLS

+ Uses various communication methods to identify and solicit information from providers and vendors as relevant to clinical and business need.

+ Coordinates, reviews and investigates claims to determine the medical necessity and appropriateness of the care

+ Determines simple cases that require review by Medical Director, Pharmacist or nurse.

+ Interprets medical review results to determine compliance with contract provisions.

+ Reports suspicions of compliance, clinical, quality, and regulation concerns

+ Identifies cases for care and cost management

+ Recommend benefit allowances in alignment with contract liabilities

+ Actively engages in communication and response with internal and external customers regarding care management, products, and services

+ Directs processing of contractual benefits after investigation is complete

+ Escalates complex cases to senior team member.

+ Requires two years (60 credit hours) of college or 2 years of healthcare experience.

+ Additional years of qualifying work experience may be considered in lieu of formal education.

+ Requires intermediate proficiency with technology applications and systems.

+ Requires experience using Microsoft office products, i.e., Outlook, Excel, Word, Teams.

+ Requires effective written and verbal communication skills.

Must reside in Kansas City Metro

Work-at-home requirements

+ Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office.

+ A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required.

+ Latency (ping) response time lower than 80 ms

+ Hotspots, satellite and wireless internet service is NOT allowed for this role.

+ A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

How we value you

+ Competitive pay/salary ranges

+ Incentive plan

+ Health/Vision/Dental benefits effective day one

+ 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution

+ Robust employee well-being program

+ Paid Time Off

+ Personal Community Enrichment Time

+ Company-provided Basic Life and AD&D

+ Company-provided Short-Term & Long-Term Disability

+ Tuition Assistance Program

While this is a remote opportunity, at this time G.E.H.A does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, Maine.

Please note that the salary information is a general guideline only. G.E.H.A considers factors such as (but not limited to) scope and responsibilities of the position, candidate’s work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer.

The hiring range for this position is $47,642 - $60,270 USD. At G.E.H.A, the current maximum salary for this role is $67,158 USD. While initial compensation may vary based on experience and qualifications, there is a path to work toward this top rate through performance and continued growth within the organization.

Please note: Due to recent fraudulent activity in the job market, if you receive correspondence from someone at G.E.H.A, we recommend you review the following facts to help verify if someone is truly a G.E.H.A employee before sharing any personal information.

+ All email addresses of G.E.H.A employees will end with our domain, @ geha.com . Any other domain is not verified and is illegitimate. **Please double check the spelling as well** .

+ We will never extend a job offer without having at least one live video call.

+ We will never ask you for or provide you with any money, personal or banking information during the interview process or before signing an offer letter.

Please report any suspicious messages to [email protected] so that we can help reduce this fraudulent activity.

Your FUTURE is here with us –COME GROW WITH G.E.H.A!

Benefits start on day one! Great 401(k) match! Tuition assistance programs! Professional development! Advancement opportunities!

For additional information, please visit GEHA Careers. (https://www.geha.com/careers)