Claims Representatives
Help our customers maintain their health, well-being and sense of security by ensuring medical claims are processed accurately and timely while protecting the confidentiality of our customer’s personal health information. Under direct supervision performs duties relating to the claims adjudication process from review of the claim form, verification of eligibility, verification of coordination of benefits with insurance carriers, and finalizing based on the health benefits plan. Technical advice and assistance will be provided by Technical Coaches.
Responsibilities
- Review claim submissions to confirm required documents have been received, verify medical codes, eligibility, other insurance, authorizations, and account benefit plans.
- Follows established policies and procedures to pay, pend for additional information, or deny claims.
- Adapt to and positively influence change by accepting feedback with a growth mindset to continuously improve.
- Follow processes and work independently to meet or exceed Key Performance Indicators (KPI)
- Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1×1 or check-ins, using a variety of virtual tools, i.e. Outlook email, Skype for Business, Cisco Web-Ex or other similar applications.
- Maintains a high level of accuracy in all duties performed.
- Team members will be held accountable for meeting and maintaining minimum quality and production standards through use of Management Operating Systems (MOS) tools: Daily Production Log (DPL), Performance Profile, Claim Review tool, and other reporting systems.
- Partner with the Resource Management Group (RMG) on Workflow Tool (WFT), pended claims, or other inventory issues.
- Partner with Technical Coaches to understand claim processes and procedures.
Experience Required:
- Must possess strong attention to detail and problem-solving skills with a high level of accuracy
- High level of computer navigational skills with experience using shortcut keys
- Proficient in Microsoft Office applications, Word, Excel, Outlook, OneNote, and Power Point
- Knowledge of medical and insurance industry terminology including CPT/ICD-10 codes
- Excellent organizational, interpersonal, written and verbal communication skills
- Experience in delivering exceptional customer service
- Ability to perform comfortably in a fast-paced, deadline-oriented work environment
- Must be able to type and use a keyboard for extended periods of time
- Integrity and personal accountability for job performance and expectations
- Proven ability to learn a variety of benefit plans
For this position, we anticipate offering an hourly rate of $16 – $24, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
Helping our customers achieve healthier, more secure lives is at the heart of what we do. While you take care of our customers, we’ll take care of you through a comprehensive benefits program that helps you be at your best. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and best in class well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and dozens of corporate discounts on essentials you use every day.