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Group Health Cooperative of South Central Wisconsin. BETTER TOGETHER
The Claims Specialist ensures the accurate entry of inpatient and outpatient claims per the data entry guidelines, and ensures the timely processing of claims per the adjudication rules for accurate payment or denial. The incumbent is also responsible for the accurate use of referral guidelines and benefit plans. Other duties include: filing; assisting outside providers, members, and staff regarding claims related questions or issues; and assisting internal staff on complex claims related questions and problems. The Claims Specialist performs under the general direction, guidance, and supervision of the Insurance Operations Manager.
The incumbent knows and abides by all Group Health Cooperative of South Central Wisconsin (GHC-SCW) organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner.The incumbent understands our Mission, Vision and Common Values (stated below) and is committed to promote these values in behavior and attitude.
Our Mission Statement: We partner with members and the communities we serve to maximize health and well-being.
Our Vision: As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve.
Our Values:
GHC-SCW is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees, members, and patients feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.
We believe:
Healthcare is a human right.
In treating all people with dignity and respect.
There is strength in diversity.
Equity celebrates our humanity.
We are better together.
JOB SPECIFIC QUALIFICATIONSGroup Health Cooperative of South Central Wisconsin is proud to be an equal opportunity employer. GHC-SCW considers candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
Full Time
$56k-70k (estimate)
04/28/2024
06/27/2024
If you are interested in becoming a Claims Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Claims Specialist for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Claims Specialist job description and responsibilities
The specialist reports and processes these claims by researching the policy and accumulating evidence regarding the claim.
02/21/2022: Benton Harbor, MI
Claims specialists must also compile reports and communicate regularly with supervisors and managers regarding the status of claims.
03/17/2022: Madison, WI
Claims Specialists are responsible for a wide range of administrative tasks related to the delivery of medical care.
03/13/2022: New Brunswick, NJ
Evaluates liability, coverage and settles claims within prescribed procedures and authority.
03/07/2022: Vallejo, CA
Reviews and evaluates property claims for coverage and further claim handling procedures to conclude within required statutory time frame.
03/03/2022: Provo, UT
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Claims Specialist jobs
Claims specialists are required to follow the California Health and Safety Code when accepting or denying claims.
02/04/2022: Lynchburg, VA
They must treat clients fairly and equitably, but also make sure claims are legitimate and reasonable.
03/03/2022: Portland, ME
They must know the details of claims verification, payment processing, dispute resolution and fraud detection.
02/14/2022: Hialeah, FL
A good claims specialist will take a proactive approach to their job.
02/21/2022: Helena, MT
Claims specialist positions require superb organization skills to keep track of financial documents.
03/26/2022: New Bedford, MA
Step 3: View the best colleges and universities for Claims Specialist.