Administrative Claims Specialist Role

1 week ago

Albuquerque, New Mexico, United States New Mexico Mutual Full time
Claims Intake Specialist Job Summary

New Mexico Mutual is seeking a highly skilled and detail-oriented Claims Intake Specialist to support the smooth operation of our Claims Department.

Key Responsibilities:
  • Provide administrative support to the Claims Department through claim intake, filing, copying, data entry, and responding to requests.
  • Perform other clerical and administrative duties to ensure efficient workflow and productivity.
Essential Functions:
  • Enter new First Reports of Injury information received by phone or other method into our system.
  • Provide limited claim instructions or information to customers; direct complex inquiries to appropriate Claims Adjusters for response.
  • Contact insured or other involved parties to obtain missing claim information.
  • Sort, scan, classify, code, and perform data entry of incoming documents and information for integration into our software systems.
  • Prepare and scan documents into the imaging system. Ensure quality assurance for all documents scanned.
  • Support the claims adjusting staff with billing issues, problems, and disputes. Coordinate response to these providers from our bill review vendor.
  • Maintain accurate records, reports, and/or files.
  • Copy and organize large volume files for transmission to legal counsel or others as appropriate.
  • Obtain W9 documents for new or changed provider address book contact according to established procedures.
  • Monitor the medical bill holds in the bill review vendor system. Notify the appropriate staff to receive direction related to these bill holds.
  • Sort incoming mail and packages. Deliver to appropriate Adjusters.
  • Act as a backup for claims administration duties within the Provider Relations Department.
  • Perform other related duties as assigned by supervisor.
Requirements:
  • High School diploma or GED equivalent.
  • 1-3 years directly related experience.
Required Skills/Abilities:
  • Bilingual in English and Spanish. Fluency in oral and written communication.
  • Excellent customer service skills with ability to communicate professionally with stakeholders.
  • Strong attention to detail and focus on accuracy.
  • Positive attitude and willingness to collaborate in a team environment.
  • 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.
Specialized Knowledge, Licenses, etc.:
  • Demonstrated proficiency in MS Office (Word, Excel, Outlook, PowerPoint).
  • General knowledge of payer-specific or medical specialty billing, as well as knowledge of ICD-9, ICD-10, and CPT coding helpful.
Values and Mission:

New Mexico Mutual adheres to the following values and mission:

  • Service Excellence: Providing exceptional service to our customers and stakeholders.
  • Trust: Building trust through transparency and accountability.
  • Ownership: Taking ownership of our work and our results.
  • One Team: Collaborating as a team to achieve our goals.
  • Boldness: Embracing innovation and taking calculated risks to drive growth and improvement.
Working Conditions:
  • New Mexico Mutual maintains general office conditions with light physical demands.
  • Employees adhere to all safety rules and regulations, including building security.
  • Employees participate in ensuring safe and efficient operating conditions that safeguard employees and facilities.
  • New Mexico Mutual maintains a drug-free environment, with drug testing prior to employment and upon a work-related accident.
  • Exposure to VDT screens.

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