Claims Processor

Primary Duties :

ï 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.

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

claim is completely resolved and check is issued.

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

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

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

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

coverage options.

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

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

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

information.

ï Train co-workers and new employees as required.

ï Perform various related duties as assigned.

Position Requirements :

ï High school diploma or equivalent required post high school education preferred.

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

position in the health care industry.

ï Must be flexible with scheduled work hours.

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

to work effectively with clients medical providers and plan members.

ï Proficient PC skills in Windows-based applications.

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

ï Must be highly organized with strong attention to detail.

ï Must be dependable and demonstrate responsible work patterns.

ï Must have a high level of professionalism and courtesy.

Key Skills

Loan Processing,Typing,Data Entry,Customer Service,Organizational skills,Basic Math,Computer Skills,Fraud,Microsoft Outlook,10 Key Calculator,Fair Housing Regulations,Food Processing

Employment Type : Full-Time

Department / Functional Area : Client Services

Experience : years

Vacancy : 1