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Claims Processing Specialist

2 months ago

Albuquerque, New Mexico, United States New Mexico Mutual Full time
Job Title: Claims Processing Clerk

At New Mexico Mutual, we are seeking a highly organized and detail-oriented Claims Processing Clerk to join our team. As a Claims Processing Clerk, you will play a crucial role in maintaining efficient operations within our high-volume, fast-paced environment.

Key Responsibilities:
  • Sort, scan, and classify incoming documents, ensuring accurate data entry and seamless integration into our software systems.
  • Manage the medical bill payment process by identifying and reporting errors to management.
  • Prepare and scan documents into the imaging system, providing quality assurance for all documents scanned.
  • Provide customer service by assisting claimants and providers, and directing complex or specific questions to the appropriate team members or departments.
  • Coordinate accommodations for injured workers and ensure the accuracy of payment processes for Pharmacy Benefit Management (PBM) and Medical Case Management (MCM).
  • Manage refund requests in a timely and efficient manner, ensuring compliance with company policies and procedures.
  • Investigate and resolve issues with returned checks, communicating with customers to arrange for alternate forms of payment if necessary.
  • Enter new First Reports of Injury information accurately into claim system.
  • Contact insured or other involved individuals to obtain any missing claim information.
Requirements:
  • High School diploma or GED equivalent.
  • 1-3 years directly related experience.
  • Excellent customer service skills, strong verbal and written communication skills, and ability to organize and prioritize work.
  • Intermediate computer skills and ability to learn new computer applications.
  • Ability to meet deadlines and respond well to direction.
Working Conditions:

New Mexico Mutual maintains general office conditions with light physical demands. Employees adhere to all safety rules and regulations, including building security.