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Our people make all the difference in our success.
Claims Representatives
Help our customers maintain their health, well-being and sense of security by ensuring medical claims are processed accurately and timely for healthcare providers and policy holders while protecting the confidentiality of our customer’s personal health information. Under direct supervision performs duties relating to the claims adjudication process from review of the claim form, verification of eligibility, verification of coordination of benefits with insurance carriers, and finalizing based on the health benefits plan. Technical advice and assistance will be provided by Technical Coaches.
Responsibilities
Review claim submissions to confirm required documents have been received, verify medical codes, eligibility, other insurance, authorizations, and account benefit plans.
Follows established policies and procedures to pay, pend for additional information, or deny claims.
Adapt to and positively influence change by accepting feedback with a growth mindset to continuously improve.
Follow processes and work independently to meet or exceed Key Performance Indicators (KPI)
Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1×1 or check-ins, using a variety of virtual tools, i.e. Outlook email, Skype for Business, Cisco Web-Ex or other similar applications.
Maintains a high level of accuracy in all duties performed.
Team members will be held accountable for meeting and maintaining minimum quality and production standards through use of Management Operating Systems (MOS) tools: Daily Production Log (DPL), Performance Profile, Claim Review tool, and other reporting systems.
Partner with the Resource Management Group (RMG) on Workflow Tool (WFT), pended claims, or other inventory issues.
Partner with Technical Coaches to understand claim processes and procedures.
Experience Required:
Must possess strong attention to detail and problem-solving skills with a high level of accuracy
High level of computer navigational skills with experience using shortcut keys
Proficient in Microsoft Office applications, Word, Excel, Outlook, OneNote, and Power Point
Knowledge of medical and insurance industry terminology required
Medical coding knowledge preferred
Excellent organizational, interpersonal, written and verbal communication skills
Experience in delivering exceptional customer service
Ability to perform comfortably in a fast-paced, deadline-oriented work environment
Must be able to type and use a keyboard for extended periods of time
Integrity and personal accountability for job performance and expectations
Proven ability to learn a variety of benefit plans
** This position will start on 6/5/23
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an hourly rate of 17 – 24 USD / hourly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.