Claim Processor

Overview Processes medical and flexible spending account claims in accordance with the provisions of multiple welfare plans administered by the Benefits Department. Approves claims involving payments up to $4,000. Utilizes Claim Facts System and Flexible Spending Account System to accomplish functions. Works with minimal supervision and is responsible for making an established range of decisions, escalating to Manager when necessary and updating Manager on a regular basis. Responsibilities What you will do: Processes medical and flexible spending account claims of any type for multiple welfare plans according to established rules and guidelines. Coordinates claims with Medicare and other group insurance carriers. Must have working knowledge of rules established by Medicare for coordination of benefits and rules established by the (NAIC) National Association of Insurance Commissioners for other group insurance. Approves claim payments up to $4,000 on personal authority. Must be capable of detecting fraud or potential fraudulent claims. Maintains a working knowledge of medical terminology to interpret medical reports and bills to properly adjudicate claims. Keeps abreast of new medical procedures and terminology. Determines proper payees for benefits in order to discharge Company's liabilities. Maintains compliance with applicable federal and state laws (e.g., HIPAA) related to privacy, security, confidentiality, and protection of personal information, including, but not limited to, personal health information and personally identifiable information. Performs other duties as assigned Complies with all policies and standards Qualifications High School Diploma Or GED. (Required) Proven examples from work experience of maintaining a high degree of accuracy associated with high volumes of work and/or multiple duties. (Required) and Demonstrated experience working effectively within a team. Must provide examples of motivating co-workers in difficult situations. (Required) and Proven examples of consistently meeting productivity and quality goals from work experience. (Required) and Experience must include identifying, defining and resolving problems, and collecting or interpreting data to establish facts, draw valid conclusions and provide solutions to problems. (Required) Demonstrated strong attention to detail with excellent organizational skills. Must cite examples of organization and time management methods used to manage or prioritize workload demands. Demonstrated excellent verbal and written communication skills with ability to convey information, verbally and in writing, to internal and external customers at all levels in a clear, accurate, focused and concise manner. Demonstrated ability to document procedures and activities in a manner that is understandable to others and prepared using a prescribed format. Verbal and written communications are to conform to proper rules of punctuation, grammar, diction and style. Proven ability to handle confidential information in a discreet manner. Working knowledge of word processing and spreadsheet applications. Demonstrated experience working independently to make decisions and demonstrate initiative. Work Setting/Position Demands: Works in an office setting and remains in a stationary position for long periods of time while working at a desk, on a computer or with other standard office equipment, or while in meetings. Requires the ability to verbally communicate and exchange accurate information to customers and associates on a regular basis. Requires visual acuity to read and interpret a variety of correspondence, procedures, reports and forms via paper and electronic documents, visual inspection involving small defects; small parts, and/or operation of machinery (including inspection); using measurement devices continuously. Visual acuity is required to determine accuracy, neatness, and thoroughness of work assigned. Requires the ability to prepare written correspondence, reports and forms using prescribed formats and conforming to rules of punctuation, grammar, diction, and style on a regular basis. Requires the ability to apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions Performs substantial movement of wrists, hands, and fingers for continuous computer work. Extended hours required during peak workloads or special projects/events. Travel Requirements: None