Position Summary: Claims processors receive all electronic and paper claims for reimbursement related to transportation services. The claims processing department handles all aspects of the claim adjudication process from receipt of the claim, signature collection, validation of clean claims, auditing and managing the claims process. Claims processors are required to navigate all internal systems, adhere to relevant state and MCO compliance requirements, evaluate estimates for total payment expectation, and effectively communicate policies internally and externally. Expected to be high performers, lead by example, and act as subject matter experts. Claims processors serve as a point of escalation for vendor claims submissions, claims research, categorizing and filing paper documents, and ensuring accuracy of all submitted vendor claims.

Responsibilities & Key Skills may direct walk-in visitors to appropriate areas.

• Serves as a point of escalation for transportation provider claim submissions, providing real-time answers or facilitating interdepartmental communications to address external providers.
• Processes mailed and electronic transportation provider claims for payment, including: external transportation vendor, mileage reimbursement, bus pass program submissions.
• Reviews and completes claim corrections, appeal requests, and conducts payment error research
• Must be able to consistently apply departmental policies and procedures to ensure compliance with all regulatory agencies.
• Adheres to defined quality standards for the handling of all claim inquiries.
• Collaborates internally to research, resolve, and educate transportation vendors and MCO members as needed.
• Assumes every issue is complex and demonstrates curiosity when receiving new inquiries to accurately identify and solve for the root issue and escalates as needed.
• Leverages active listening to identify any unspoken need and strives to anticipate and eliminate any follow up or additional work for the customer.
• Sets clear and reasonable expectations for vendors and members, adequately documents to communicate forward the circumstances for others, and demonstrates strong follow up and follow through to meet all set expectations.
• Produces high quality results that eliminate additional work for others including customers, peers, or other departments by being thorough and taking ownership of all inquiries.
• Be adaptable to workflow change

Requirements:

• HS diploma or GED
• Minimum of 3 years' experience working in claims and appeals, customer service; or any combination of education and experience which would provide an equivalent background.

Minimum Qualifications (Education, Experience, Skills)

• Requires advanced communication, interpersonal and organizational skills; successful completion of Queue Adjustment Simulation test; monitor queues, trip error coaching, ability to successfully edit/add provider and verification forms. Daily report outs. Ability to perform duties such as telephone, e-mail, cancellation web-chats, Trip assignments/ returns, voicemail, fax, and written inquiry functions on demand;
• Knowledge of personal computing and Windows based software applications such as Introduction to Windows, Basic Word, Basic Excel; and Basic Internet skills.
• Ability to work Monday-Friday 8:00am to 8:00pm.
• Demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, the company's internal business processes, and internal local technology is strongly preferred.
• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Ability to commute/relocate:

• Indianapolis, IN 46278: Reliably commute or planning to relocate before starting work (Required)
• Hybrid work model - AFTER 6 MONTHS

Job Type: Full-time

Salary:$20.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Work setting:

• In-person