Associate, Claims Administrator

4 weeks ago

Wilmington, United States Ametros Financial Corporation Full time
A Claims Administrator is primarily responsible for ensuring timely and accurate payments of member claims. The position requires excellent phone and email skills with the ability to adapt correspondence to a wide variety of audiences, including attorneys, claims adjusters, claimants, physicians, and structured settlement brokers.? The role works closely with the client engagement team, member care team, and management team to keep our members happy and compliant with their settlements.

  • Assess if billed services are related to a member's accident or injury.
  • Assess if billed services are compliant within the guidelines of the member's settlement.
  • Review settlement documentation to evaluate prior authorization requests.
  • Manage the bill payment process including detailed review and analysis of claims to ensure proper treatment of funds.
  • Maintain expected turnaround times in assigned claims statuses.
  • Identify claim issues, and work towards a fast resolution.
  • Handle incoming & outgoing claim calls, emails, and chats while maintaining a pleasant and helpful demeanor.
  • Record, track and follow up on all correspondence while maintaining member confidentiality.
  • Coordinate with providers to proactively resolve billing errors and/or discrepancies.
  • Act as a resource for member care and pharmacy agents in need of billing assistance.
  • Assist in identifying enhancements within existing processes.
  • Lead or participate in special projects as assigned by Management.
  • Demonstrates a commitment to service by consistent attendance and punctuality.

Requirements

  • Well versed with healthcare and medical terminology
  • Meticulous attention to detail
  • Highly organized and focused with the ability to prioritize and multitask
  • Aptitude for problem-solving
  • Sound business judgment and computer skills
  • Excellent written and verbal communication skills with ability to adapt communication style depending on audience
  • 2-4 years of experience with ICD-10, CPT, NDC and HCPCS coding and procedures
  • Understanding of Worker's Compensation and Medicare coverage guidelines
  • Ability to work independently and as part of a team
  • A desire to continue to learn and improve both self and the organization
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