Claims Clerk

JOB DESCRIPTION

SUMMARYThis 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.

Qualifications

High school diploma or equivalent and one (1) to three (3) years of Business experience with knowledge of generally accepted procedures, analytical abilities or equivalent combination of education and experience preferred. Knowledge of generally accepted health care eligibility and billing procedures as well as Health Insurance Portability and Accountability Act (HIPAA). Computer aptitude with Word, Excel and Outlook and the ability to develop a strong proficiency working with a proprietary Health Care system. Experience providing Customer Service to a variety of client contacts via email and telephone. Ability to research and resolve technical issues and/or client problems as they arise with minimal direction. Proficient written and oral communication skills to include modern business communications, formatting of professional letters, reports, and phone etiquette. Skills to establish priorities, multi-task, work under pressure and deadlines, work independently with minimal supervision or in team environment. General knowledge of health insurance operations and industry. Ability to work overtime as needed, based on department needs Spanish bilingual (verbal/written) abilities a plus.

Duties And Responsibilities

Clerical Support Review and sort incoming USPS mail for distribution to outside vendors or internal personnel Review and sort claims and supporting documents, received via fax and email. Prescreen, prep and scan documentation for distribution to examiners. Organize, log and process special handling checks which are returned to department, in accordance with clients specified requirements. Review and return incomplete claims which are unidentifiable and cannot be processed by Examiners. Serve as daily support for company receptionist. Serve as pre-processor of medical and dental claims. Review and post claim payment information from outside vendor as needed. Upload, from Wellpoint Anthem system, claims for priority distribution for end of contract. Department Operations Maintain department standards and production goals. Monitor logs, prescreening daily for timely processing. Log and process, in accordance with client specifications, checks requiring client second signature and mail accordingly. Sort, log and distribute various specialty checks. Log, Monitor and report daily paper, correspondence claims inventory. Keep record of work complete for weekly inventory reports. Other Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results. 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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