Risk Management Support Specialist

At Allstate, great things happen when our people work together to protect families and their belongings from life’s uncertainties. And for more than 90 years our innovative drive has kept us a step ahead of our customers’ evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection. 

Job Description

Role of a Risk Management Support Specialist is to support the Medical Management Team by gathering, reviewing, logging/tracking referrals, requesting medical records, requesting authorizations, and assigning additional medical records received. Follow up on status requests received from our claims third party administrator, on medical records requested, authorizations requested, and any additional medical records required. This role also makes outbound calls to applicants who are ineligible for coverage, providing information causing ineligibility, and instructions regarding their right to appeal.

Essential Duties and Responsibilities:

Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

• Review and organize assigned reports to identify follow-up functions for assignment purposes within the Medical Management area (eligibility verification, requesting medical records, initiation of benefit review, etc) to further assist the clinical and non-clinical staff functions
• Log referrals and maintain additional databases according to established workflows
• Complete system documentation according to department policies and workflows
• Preview various referrals for completion of the information for review
• Request/obtain authorizations from members
• Request required medical records from medical record retrieval vendor
• Request required/and or additional medical information from claims vendor using verbal and written communication
• Identify trends/issues related to the workflow process and assist with communication between claims, customer service, and medical management
• Provide administrative support to the medical management staff

Minimum Skills and Competencies:

The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Bachelor’s degree or in-lieu of degree equivalent education, training and work-related experience
• 3+ years of experience with health insurance processes and terminology
• 1+ years of customer service experience, managed care experience or health insurance experience
• 1+ years of working knowledge of basic health insurance and medical terminology
• 1+ years of experience working with ICD-10 and CPT coding
• Critical thinking skills
• Knowledge of the difference between clinical and non-clinical decisions
• Excellent word processing and data entry skills with the ability to perform accurate data entry
• Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
• Data gathering skills and the ability to work with minimal supervision
• Ability to communicate effectively through written communication methods
• Requires the ability to follow written procedures
• Great organizational skills and the ability to multitask in a timely fashion
• Excellent verbal and written communication skills

Supervisory Responsibilities

• This job does not have supervisory duties.

#LI-MS2

Skills

Compensation

Compensation offered for this role is $18.65 - 29.54 per hour and is based on experience and qualifications.

The candidate(s) offered this position will be required to submit to a background investigation.

Joining our team isn’t just a job — it’s an opportunity. One that takes your skills and pushes them to the next level. One that encourages you to challenge the status quo. And one where you can impact the future for the greater good.  

You’ll do all this in a flexible environment that embraces connection and belonging. And with the recognition of several inclusivity and diversity awards, we’ve proven that Allstate empowers everyone to lead, drive change and give back where they work and live. 

Good Hands. Greater Together.

Allstate generally does not sponsor individuals for employment-based visas for this position.

Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component.

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