RESPONSIBILITIES
Analyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system issues that are beyond the scope of claim examiners and senior claim examiners that affect claims payment. Act as consultant to claims staff in complex claim issue resolution. Work cooperatively with Configuration in testing of contracts used in business operations and reporting to assure auto adjudication. Perform in accordance with company standards and policies. Promote harmonious relationships within own department, with other departments and within CFHP. Operate under limited supervision.
EDUCATION/EXPERIENCE
High school diploma or GED equivalent is required. Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred. Knowledgeable of all benefit programs offered by the CFHP, Medicaid, HMO, PPO, ASO.
University Health is the only locally owned health system in San Antonio. For more than 100 years, University Health has been here to heal, improve health, train the next generation of medical professionals and ensure the people of San Antonio, Bexar County and South Texas have access to primary and advanced specialty care close to home.
Almost 11,000 employees and more than 1,200 physicians provide specialized services, including the region’s only Level I trauma center for both adults and children, and maternal and neonatal intensive care centers designated at the highest levels by the State of Texas.
As the region’s only academic health system, University Health is a hub of innovation and discovery, committed to delivering patient-centered, culturally competent, high-quality and compassionate care, based on a strong foundation of outcomes‐based research and innovative teaching.
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