Job Essentials
1. Uses proper plan documentation to determine benefits and correctly adjudicates general and specialty claims.
2. Correctly logs, adjudicates and completes paper claim process within required timeframe.
3. Identifies and forwards specialty claims to the appropriate queue.
4. Provides backup for claims processors and examiners. Supports other departments as needed.
5. Meets and maintains the minimum production standard as defined in the department compensation program.
6. Maintains the minimum accuracy standard as defined in department compensation program.
7. Effectively participates in meetings, trainings, and committees as designated by the supervisor.
8. Provides a level of superior customer service that is consistent with company standards and goals; including outbound calls to members, providers, facilities, and other departments or teams.
9. Documents all calls in member call tracking using the correct tracking codes and detailed comments of the conversation.
10. Reviews feedback from supervisors, trainers, auditors, examiners, and trending spreadsheets. Identifies and implements the required steps for improvement.
Minimum Qualifications
One year of claims processing, claims logging, or customer service experience.
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Demonstrated minimum of 100 SPM on ten key and 30 WPM typing.
Preferred Qualifications
Problem solving ability, analytical skills, self-motivated, and able to work well under pressure. Health plan customer service experience or claims processing experience.
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Demonstrated excellent verbal and written communication skills. Experience taking incoming and/or outgoing calls in a professional work environment.
Additional Job Description:
SH only
Hearing/Listening, Manual Dexterity, Seeing, Speaking