A Benefits Investigation Specialist is a health care professional who works to ensure that the patient’s health care benefits cover all required procedures. While the duties vary based on the work setting, the following are certain core duties identified on the Benefits Investigation Specialist Resume –contacting the patient’s insurance company to verify coverage levels; educating people about their eligible benefits; helping patients get medical procedures as needed, assisting patients in renewal or application process, updating patient information in the database; and verifying the accuracy of existing information.
Those seeking this job role must have experience working with insurance companies, and possess extensive knowledge of different types of coverage and policies; they should be well-versed in relevant software applications and have the ability to work on many projects at once. The minimum education requirement includes only a high school diploma or GED, however, those with a degree or work experience in billing setting are preferred.
Objective : As a Benefits Investigation Specialist is working part of a team that provides quality customer service by helping client candidates, employees, retirees, and others understand, work with, and use their HR plan(s) accurately and effectively, acting as a liaison for the customer and work with him or her to resolve basic, straight forward questions and issues arising from inbound calls, on-line secured requests from client employees, and written requests from client employees and/or HR contacts.
Skills : Specialised in organisational communication, Proficient In Microsoft Office, Studied different managerial styles, Customer Service, Event Planning.
Description :
Asked appropriate questions regarding patient's benefits and complete data entry and or appropriate forms to document patient's benefits coverage.
Worked with public and private payers handle benefit insurance inquiries at assigned facility.
Interfaced appropriately with insurance administrators, physician's offices, patients and internal personnel.
Developed and maintained close interface with all components of the benefits process.
Ensured that related information is obtained, documented, tracked and available for review.
Performed related duties as assigned.
Worked with public and private payers to handle benefit insurance inquiries as a means of ensuring medical plans were established for clients.
Experience
2-5 Years
Level
Executive
Education
GED
Benefits Investigation Specialist Resume
Headline : Motivated Benefits Investigation Specialist professional possessing a strong commitment to quality customer service coupled with superb communication skills. Builds customer loyalty by effectively resolving problems and quickly processing transactions.
Skills : Property management computer software programs, OneSite and Yardi proficiency, Supervisory , Data Entry and Processing.
Description :
Contacted health insurance companies and providers, to investigate and verify patient benefits, eligibility, and financial responsibilities.
Analysed all information received, working with nurses and clinical staff to resolve clinical requirements for prior authorisations, and referrals.
Interfaced appropriately with insurance administrators, physician offices and end users.
Developed and maintained database records.
Provided exceptional customer service to internal and external customers.
Resolved any customer requests in a timely and accurate manner.
Escalated complaints accordingly.
Experience
5-7 Years
Level
Executive
Education
High School Diploma
Benefits Investigation Specialist Resume
Headline : Driven Benefits Investigation Specialist professional seeking an administrative position. Quick in understanding client's needs and seeing the big picture. The ability to present alternatives and make recommendations for organizational efficiency. Highly skilled in effective team and customer relationship building.
Skills : Forklift Certified, Moffett Certified.
Description :
Processed requests from patients and health care provides to research insurance benefits and coverage requirements.
Followed-up with the primary site coordinator when there is a discrepancy.
Communicated with insurance Providers to identify correct coding and benefits for program provider.
Created precise notes to indicating details about benefits, diagnosis, effective dates of coverage and out of pocket expenses.
Provided a full range of customer service support.
Specialised in benefit verification for patient and physicians.
Complied with al HIPPA guidelines, policies, and regulations.
Experience
5-7 Years
Level
Executive
Education
Business Administration
Benefits Investigation Specialist Resume
Summary : To obtain a Benefits Investigation Specialist position as a team-player in a people-oriented organisation where I can maximise my customer-service and data entry experience in a challenging environment to achieve and exceed the corporate goals.
Skills : Microsoft Power Point, Investigating Skills.
Description :
Contacted insurance companies on behalf of the physician's office to verify patient benefits.
Investigated and documented patient's benefits coverage.
Coordinated with provider's office to assist in prior-authorisation.
Worked with public and private payers, assisted in the use of our web portal.
Responsible for trouble shooting issues and educating the end user on functionality.
Interfaced with insurance administrators, physician's offices, patients and internal personnel.
Worked with public and private payers, handle benefit insurance inquiries at assigned facility.
Experience
10+ Years
Level
Senior
Education
B.S. In Information Technology
Benefits Investigation Specialist Resume
Objective : To find a Benefits Investigation Specialist position where my positive attitude, exceptional customer service skills, and motivation will contribute to the success of a company's team.
Skills : PowerPoint, Stellar Customer Service, Type 60 Wpm.
Description :
Interfaced appropriately with insurance administrators, physician's offices, patients and internal personnel.
Developed and maintained close interface with all components of the benefits process.
Interfaced appropriately with insurance administrators, physician's offices, patients and internal personnel; maintained good housekeeping practices.
Developed and maintained close borders with all components of the benefits process by using several intricate medical/insurance software programs.
Ensured that related information was obtained, documented in detail for tracking and availability for access and quality review.
Developed target numbers for annual savings from available healthcare insurance options.
Identified new opportunities that may affect future savings through changing market conditions or trends in health care costs.
Experience
2-5 Years
Level
Executive
Education
Master Of Arts
Benefits Investigation Specialist Resume
Headline : Have worked in the area of Benefits Investigation Specialist for the last five years. I have experience with special skills in client relationship building. I am a conscientious go-getter, organised, efficient, honest, and reliable professional, who is attentive to detail, produces quality work while maintaining production targets.
Identified and analysed benefits program structures, structures, policies, and procedures.
Identified benefits programs that are effective in achieving organisational goals.
Identified the impact of changes in benefit programs on the organisation's performance at various levels (individuals, teams, departments).
Measured the effectiveness of benefit programs at all levels of the organisation.
Developed a plan to evaluate each benefit program to determine its effectiveness in achieving organisational goals.
Prioritised those that need improvement or modification.
Developed a plan to address any deficiencies identified during the evaluation process.
Experience
5-7 Years
Level
Executive
Education
High School Diploma
Benefits Investigation Specialist Resume
Objective : Benefits Investigation Specialist is responsible fro Preparing benefit program reports for internal review and compliance with regulatory requirements, Processing benefits for compliance with legal requirements (e.g., HIPAA), Supporting the development of benefit programs that align with company values, policies, and/or company strategy.
Skills : Planning, Developing, Application Laws.
Description :
Ensured compliance with all applicable laws and regulations regarding benefit agreements.
Identified trends in reports of suspected benefit fraud (e.g., trends in numbers of reports, types of reports, etc.) and develop a plan to combat these trends so that they are not.
Gathered information from internal stakeholders regarding health insurance options.
Analysed available options, determine best fit for client, create a plan of action for each option.
Worked with internal and external stakeholders to understand the benefits and risks associated with healthcare insurance options.
Worked with clients to develop customised plans of action for each option.
Developed a financial plan for each option in order to calculate current value of policy, estimate future value, and generate ROI on the long term investment in coverage.
Experience
2-5 Years
Level
Executive
Education
MS
Benefits Investigation Specialist Resume
Objective : As a Benefits Investigation Specialist, responsible for Identifying emerging trends affecting benefits programs (e.g., new healthcare mandates) and discuss with senior leadership to keep up-to-date on trends in this area, Identifying opportunities to improve benefit programs without changing existing policies or procedures (e.g., transfer of health plan coverage from one carrier to another).
Skills : Planning, Programming, Leadership.
Description :
Assessed the eligibility of all benefits, including non-cash benefits, for all plans and their respective tax implications.
Provided documentation to support claims we will not accept claims without documentation.
Followed the legal requirements of the benefit plan(s) in question (including any regulations or policy).
Ensured that all documents are in compliance with all applicable laws, regulations and company policies.
Worked closely with HR to develop a comprehensive benefits plan structure.
Monitored current state of affairs as well as trends in utilisation, utilisation trends, cost structures and quality issues.
Developed a plan to meet current utilisation standards and to maintain compliance with regulatory standards on a timely basis.
Experience
2-5 Years
Level
Executive
Education
MA
Benefits Investigation Specialist Resume
Objective : To obtain a Benefits Investigation Specialist, responsible for Providing a full analysis report on all benefits offered by the company, including a list of all policies and procedures used in any specific benefit programs, Performing research and interview with stakeholders involved in any specific benefit programs to assess their impact on job satisfaction organisational performance (e.g., employees involved in specific benefit programs, external stakeholders).
Skills : HR, Stakeholder, Planning.
Description :
Led a team of Analysts who will assist in meeting this responsibility.
Identified new benefit programs and implement them in an effective manner to meet business objectives.
Provided expert analysis of the impact of new benefit programs on the organisation's P&L.
Monitored the effectiveness of benefit programs by quantifying the value of each program based on the number of beneficiaries it serves, program costs per beneficiary, program duration, and other factors.
Analysed existing benefit programs to identify areas that can be improved or eliminated to optimise program effectiveness.
Suggested strategies for improving performance.
Coordinated with internal staff to develop a plan for future benefit programs.
Experience
2-5 Years
Level
Executive
Education
MS
Benefits Investigation Specialist Resume
Objective : Benefits Investigation Specialist is responsible for Identifying and analysing benefits programs offered by the company, Identifying and analysing benefits programs that meet the objectives of the company, Analysing cost effectiveness of benefits programs offered by the company, Providing recommendations to improve or reform existing benefits programs.
Skills : Analysing, Programming, HR.
Description :
Cooperated with external stakeholders to assist with the development of policies.
Investigated allegations of benefit fraud and identify potential fraudsters and perpetrators.
Determined the extent of the alleged fraud, prioritize the cases for investigation, and develop investigative strategies for each case.
Recommended appropriate action based on the information gathered during investigation.
Provided recommendations to HR management for corrective action or management training to prevent future fraud.
Collaborated with other HR groups within the company to ensure compliance with all applicable laws and regulations regarding benefits agreements and employee benefits programs.
Ensured compliance with all applicable laws and regulations regarding benefits agreements and employee benefits programs.
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