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Claims Processing Associate
3 months ago
JOB OVERVIEW:
Claims Processing Associate will be responsible for the administration and claims processing for day-
to-day operations. Handling and document incoming calls. Research and adjust claims received from
clients and the ability to adjudicate claims in the system as needed.
ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:
Claims Processing Associate is responsible for the administration and claims processing of the day-to-
day operation of group benefits program.
Handle all incoming calls quickly and efficiently while delivering quality customer service to the caller.
Provides ideas to improve existing programs and monitors benefit administration.
Document all incoming provider calls into call tracking.
Handle all incoming research and adjust claims received from clients with resolution including portal
requests, direct call and faxed requests.
Ability to adjudicate claims in the system as needed.
Enter new providers into the system.
Responsible to provide claims reporting to Management and clients.
Other duties as assigned.
ADDITIONAL RESPONSIBILITIES:
Maintains confidentiality of provider information.
Provides Claims Processing Associate customer service.
Performs other duties as assigned.
QUALIFICATIONS:
Education- High school diploma or equivalent
Experience: 2+ years of related professional customer service
Skills:
Knowledge and understanding of Pharmacy/Medical terminology
Ability to organize and prioritize work and manage multiple priorities.
Excellent verbal and written communication skills including, letters, memos and emails.
Excellent attention to detail. Ability to research and analyze data. Ability to work independently with minimal supervision, demonstrate self-motivation and willingness to learn Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization. Proficient use of Microsoft Office applications (Word, Excel, Outlook) and internet resources. Physical Requirements: Hearing: Adequate to perform job duties in person and over the telephone. Speaking: Must be able to communicate clearly to provider and members over the telephone. Vision: Visual acuity adequate to perform job duties, including reading information from printed sources and computer screens. Other: Requires occasional lifting and carrying items weighing up to 20 pounds unassisted. Requires frequent bending, reaching, and repetitive hand movements, standing, walking, squatting and sitting, with some lifting, pushing and pulling exerted regularly throughout a regular work shift. The above is intended to describe the general content and requirements for the performance for this position. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.
