Job Description

Primary Duties:

• Receive, analyze and process assigned claims by product (medical, dental, vision, FSA or HRA) and group. Ensure accurate processing based on benefit plan design and/or regulations.
• Evaluate underpayments, resolve non-payments and rejected claims. Follow through until the claim is completely resolved and check is issued.
• Create appropriate Explanation of Benefits or letter to provider for each claim.
• Identify and escalate claims for review or audit based on business rules.
• Ensure required documentation or reporting is completed timely and accurately.
• Answer incoming telephone calls related to claim processing, provider support and member benefit coverage options.
• Make outgoing calls to members and providers to obtain additional information as needed.
• Retrieve and sort mail, fax and email to ensure timely and accurate handling and response.
• Perform clerical functions including data entry, filing, and sorting, typing, organizing, and recording information.
• Train co-workers and new employees, as required.
• Perform various related duties as assigned.

Position Requirements:

• High school diploma or equivalent required, post high school education preferred.
• Minimum two years of experience as a medical claims processor, medical biller or a similar service position in the health care industry.
• Must be flexible with scheduled work hours.
• Must have strong customer service orientation and excellent communication skills, and the ability to work effectively with clients, medical providers and plan members.
• Proficient PC skills in Windows-based applications.
• Ability to be flexible and quickly adapt to the changing needs in the department.
• Must be highly organized with strong attention to detail.
• Must be dependable and demonstrate responsible work patterns.
• Must have a high level of professionalism and courtesy.

PHYSICAL DEMANDS

This position requires sitting, standing and occasional light to medium lifting.