Primary Job Responsibilit
1. Administers, analyzes, adjudicates and processes claims in accordance with benefit contracts and plan policies; assists department to resolve more complex claim issues; maintains claim records. Works closely with other departments for any inquiries regarding claims processed.
2. Maintains required production and quality standards as established by the department and contributes to the accomplishment of team goals.
3. Provides clinical review of pre-authorization claims or prepare claims for Consultant review based on the procedures submitted. Works directly with the Consultant to resolve issues and determine benefit.
4. Provides character correction of claims or other documents submitted from customers or providers into our processing system which consists of assisting the Claims Department with OCR processing and/or claims processing worklist, as needed or when mail volume is low.
5. Opens mail to prepare for sorting, prepping and counting of incoming daily mail.
6. Scans prepared claim batches into Optical Character Recognition system for claims processing; Scans prepared customer service documents into system for processing.
7. Collects and meters outgoing mail; prepares/ships packages and mail using appropriate vendor and cost center; verifies that items are addressed correctly, marked with the proper postage, and in suitable condition for processing.
8. Separates and delivers incoming mail, packages, and inter office mail by individual.
9. Serves as backups to other team members within departments and Fulfillment
Position requires a high school diploma or equivalent and one year + experience working in a claims, medical or dental related position. Will accept any suitable combination of education, training, or experience.