Claims Processor - #259679

Job Details

Description

Primary Duties:

 Receive, analyze and process assigned claims by product (medical, dental, vision, FSA or HRA) and

group. Ensure accurate processing based on benefit plan design and/or regulations.

 Evaluate underpayments, resolve non-payments and rejected claims. Follow through until the

claim is completely resolved and check is issued.

 Create appropriate Explanation of Benefits or letter to provider for each claim.

 Identify and escalate claims for review or audit based on business rules.

 Ensure required documentation or reporting is completed timely and accurately.

 Answer incoming telephone calls related to claim processing, provider support and member benefit

coverage options.

 Make outgoing calls to members and providers to obtain additional information as needed.

 Retrieve and sort mail, fax and email to ensure timely and accurate handling and response.

 Perform clerical functions including data entry, filing, and sorting, typing, organizing, and recording

information.

 Train co-workers and new employees, as required.

 Perform various related duties as assigned.

Position Requirements

 High school diploma or equivalent required, post high school education preferred.

 Minimum two years of experience as a medical claims processor, medical biller or a similar service

position in the health care industry.

 Must be flexible with scheduled work hours.

 Must have strong customer service orientation and excellent communication skills, and the ability

to work effectively with clients, medical providers and plan members.

 Proficient PC skills in Windows-based applications.

 Ability to be flexible and quickly adapt to the changing needs in the department.

 Must be highly organized with strong attention to detail.

 Must be dependable and demonstrate responsible work patterns.

 Must have a high level of professionalism and courtesy.