Job Description
Job Description
As a Senior Claims Medical Processor, a qualified candidate will work within our growing Health Benefit Fund team supporting our wide array of union members. Member services standard hours are between 8 - 5 pm. This is an in-house, onsite position.
Responsibilities:
- Accurately process claims by researching benefits, claim policies, procedure and reviewing claim edits.
- Answer incoming telephone calls to assist customers with explanations and issue resolution of healthcare policies, benefits, eligibility and coverage.
- Understand and update claim system configuration.
- Process claim adjustments, voids, and refunds.
- Maintain claim resources, reference materials and training tools.
- Manage daily workloads to ensure production goals are met and calls are resolved timely.
- Verify accurate data entry, to include correct patient, coding, dollar amounts and provider information.
- Maintain accuracy levels of 98% or higher for both payment and statistical data.
- Work in assigned work groups/queues and assist in other areas as needed.
- Work closely with senior staff, maintaining daily communication/updates.
- Ability to train and coach others.
- Ability to handle more complex cases and serve as a subject matter expert.
- Perform other duties as assigned.
Required Qualifications:
- High School Diploma or equivalent.
- Knowledge of medical/insurance terminology.
- Extensive knowledge of ICD-10, CPT, and CDT.
- Excellent customer service – member first mentality
- Research skills and ability to evaluate claims in order to resolve accurately.
- Ability to interpret health plan contracts and benefit language.
- Excellent oral and written communication skills that are shown in a respectful, pleasant and professional manner.
- Work habits that include punctuality, ability to be a team player, willing to assist and support peers, as well as work independently with minimal direction.
- Excellent negotiation, analytical, and problem solving skills.
- Ability to prioritize workloads and perform under time pressures.
Preferred Qualifications:
- Five years’ experience as claims processor
- Ability to determine and process Coordination of Benefits, claims adjustments, and stop loss coverages.
- Experience performing claim audits.
- Experience taking inbound calls.