Claims Processor

2 months ago

Irvine, California, United States Western Growers Full time

Job Summary

This position reports to the Supervisor, Claims Operations in a production environment and is responsible for supporting the claims department by preparing claim receipts and all related correspondence for the department.

Key Responsibilities

  • Prepare and process claims and supporting documents received via USPS, fax, and email.
  • Prescreen, prep, and scan documentation for distribution to examiners.
  • Organize, log, and process special handling checks in accordance with client specifications.
  • Review and return incomplete claims that are unidentifiable and cannot be processed by examiners.
  • Provide daily support for the company receptionist.
  • Pre-process medical and dental claims.
  • Review and post claim payment information from outside vendors as needed.
  • Upload claims from the Wellpoint Anthem system for priority distribution.

Department Operations

  • Maintain department standards and production goals.
  • Monitor logs and prescreen daily for timely processing.
  • Log and process checks requiring client second signature and mail accordingly.
  • Sort, log, and distribute specialty checks.
  • Log, monitor, and report daily paper and correspondence claims inventory.
  • Keep records of work complete for weekly inventory reports.

Additional Responsibilities

  • Utilize all capabilities to enhance the competitiveness and profitability of our members.
  • Be willing to adjust efforts to ensure work and attitude are helpful to others.
  • Be self-accountable, create a positive impact, and deliver results.
  • Perform all other duties as assigned.

Physical Demands/Work Environment

The physical demands and work environment described here represent those that an employee must meet to successfully perform this job's essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.

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