Job description

The Seminole Tribe of Florida's Health Plan Team is responsible for providing quality Medical and Dental Health care providers to the Tribal Community while assuring cost-effectiveness and excellent customer service. This program functions under the leadership of the Health & Human Services department and addresses healthcare challenges while ensuring the best customer service experience whether in claim payment, claims appeals, pre-certifications, contract negotiations, coordination of benefits with plans or networks and eligibility. Quality patient care and payments are at the forefront. Learn more at https://www.semtribe.com/stof/services/health-and-human-services

Note it's full-time Monday to Friday 8am to 5pm with an hour lunch. The main location is the Hollywood Reservation 111 W Coral Way, Hollywood, FL 33021. We have 3 other Clinics so as-needed there would be some local day travel to other Reservations in Clewiston, Okeechobee, and Immokalee. You can use a Tribal vehicle to go between the Reservations.

Position Summary

The incumbent in this position is responsible for auditing and reviewing employee’s benefits activities and processing health claims, including analyzing payments, procedures and guidelines of benefits. The individual investigates the validity of claims, reviews and settles benefit claims and processes claims for payment ensuring that STOF employees and Tribal Member’s health insurance claims are processed and resolved in a timely manner. The individual provides guidance to Tribal Members and employees on health insurance claims. The incumbent maintains accurate case files and issues reports on general claims activity.

Qualifications / Requirements

Bachelor’s degree in Health Administration, Accounting, Business Administration, Human Resources Management or related field is required. A minimum of three (3) years of experience working as claims auditor, benefits coordinator or experience processing insurance claims is required; or an equivalent combination of education/training and experience will be considered. Possession of a valid Florida Driver’s License is required. Demonstrate excellent customer service and organizational skills. Demonstrate excellent written and verbal communication skills. Demonstrate proficiency utilizing Microsoft software packages. Ability to work a flexible schedule including evenings, weekends and holidays.

About STOF

The Seminole Tribe of Florida is a federally recognized Native American Tribe and sovereign Tribal Government, dedicated to providing high quality care and services to its members who reside on reservations throughout South Florida; Hollywood, Big Cypress, Brighton, Fort Pierce, Immokalee, Tampa and two satellite offices located in Naples and Miami (Trail).

With our Headquarters based in Hollywood, Florida, The Seminole Tribe of Florida has approximately 2,000 employees spread throughout our Reservations. The Tribe has developed numerous employment opportunities through a broad range of services such as Accounting, Education, Public Works, Media Productions, Community Planning, Recreation, Credit & Finance, Health, Museum, Public Safety, Legal, Information Technology and Elder Services, along with many others. The Seminole Tribe of Florida has more non-contiguous reservations than any tribe in North America. Take a walk through our six reservations by visiting us online at www.semtribe.com

Job Type: Full-time

Pay: $27.00 - $29.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday
• Weekend availability

Application Question(s):

• This position is Monday to Friday 8am to 5pm with an hour lunch located at 111 W Coral Way, Hollywood, FL 33021. You would be based on-site in Hollywood however occasionally you would need to drive to other Reservations as needed to Clewiston, Immokalee and Okeechobee. While not often, those days we'll include drive time into your regular schedule and there is a departmental vehicle you can use to travel between sites. Are you ok with the schedule and commute?
• Are you a current or previous Seminole Tribe of Florida Employee? This includes their businesses like the Hard Rock and Casinos. If so, please indicate position and employment dates.
• Are you a Tribal Member of the Seminole Tribe of Florida? If not Seminole FL, are you a registered member of another federally recognized Native American Tribe? If Yes, please specify Tribe. Note: A Native American Tribal Document is not required to establish work eligibility, but it must be presented upon hire for classifications purposes.

Education:

• High school or equivalent (Required)

Experience:

• health care claims auditing or billing coding: 2 years (Required)

License/Certification:

• Florida Driver's License (Required)

Work Location: In person

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