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Medical Claims Processor

2 months ago

Metairie, United States CCMSI Full time
Job Title: Benefit Claims Processor

About the Role:

We are seeking a highly skilled Benefit Claims Processor to join our team at CCMSI. As a Benefit Claims Processor, you will be responsible for processing medical, dental, and prescription drug card claims for assigned accounts according to individual client contracts.

Key Responsibilities:

  • Interpret plan documents to resolve claims problems, review denials, subrogations, or coordination of benefits with assistance from other staff or Medical Reviewer as needed.
  • Properly and expeditiously handle medical, dental, and prescription drug card claims processing and payment according to the assigned client's Schedule of Benefits and contract provisions.
  • Work closely with the client's Plan Administrator or other designated individual(s) to resolve any claim problems related to the account or provide needed information.
  • Answer client questions, including but not limited to claims payment status and coverage information for assigned accounts.
  • Answer questions from Benefit Analysts, Senior Benefit Analysts, and other members of the team, serving as a resource for questions or problem resolution for less experienced team members.
  • Upon receipt of claims, review and process on computerized adjudication system for payment under the client's Schedule of Benefits and contract.
  • Other related duties include contacting client or healthcare providers for refunds on overpayments or errors on claims processed, entering pertinent employee information for new accounts, and ensuring claims are processed within the policy year or run-out period for incurred/paid contracts.
  • Following completion of the claims process/payment, all related paperwork to Support Services, unless the claim is a specific or hold claim.

Requirements:

  • Excellent oral and written communication skills.
  • Initiative to set and achieve performance goals.
  • Good analytic and negotiation skills.
  • Ability to cope with job pressures in a constantly changing environment.
  • Knowledge of all lower-level claim position responsibilities.
  • Must be detail-oriented and a self-starter with strong organizational abilities.
  • Ability to coordinate and prioritize required.
  • Flexibility, accuracy, initiative, and the ability to work with minimum supervision.
  • Discretion and confidentiality required.
  • Reliable, predictable attendance within client service hours for the performance of this position.
  • Responsive to internal and external client needs.
  • Ability to clearly communicate verbally and/or in writing both internally and externally.

Education and/or Experience:

High school diploma or equivalent.

3+ years claims experience.

Medical terminology required.

Computer Skills:

Proficient with Microsoft Office programs.

Certificates, Licenses, Registrations:

None required.

Core Values & Principles:

Responsible for upholding the CCMSI Core Values & Principles, which include performing with integrity, passionately focusing on client service, embracing a client-centered vision, and maintaining contagious enthusiasm for our clients.

CCMSI is an Affirmative Action/Equal Employment Opportunity employer offering an excellent benefit package, including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP, and 401K.