What are the responsibilities and job description for the Claims Coordinator position at National Healthcare Solutions, Inc.?
About Us
We are a dynamic enterprise group of managed care and health insurance service companies which have become industry leaders in their diverse specialties. Headquartered in Dallas, Texas, the group has 10 offices around the world, including the United States, Canada, Panama, Ecuador, Colombia, and Dubai, and employs over 700 employees of various nationalities.
Position Summary
The Claims Coordinator addresses inquiries, questions and concerns regarding claims, including but not limited to coverage details, benefit limits, explanation of denials, and payment status of claims. The position is responsible for receiving, responding to, and directing members, broker and provider phone calls and other communications assuring to provide available information upon request and escalating issues as appropriate.
ESSENTIAL FUNCTIONS
- Receives customer calls or inquiries, which include potential/current/previous members, brokers and providers.
- Provides timely and accurate information to customers
- Processes customer requests according to established department policies and procedures.
- Completes research and investigative activities to address customer inquiries.
- Works closely with claim adjudicators and other departments to gather information.
- Provides timely feedback to customers through outbound calling, email, mail or fax.
- Identify potential fraudulent claims and take appropriate action.
- Attend to client office visits.
- Provides timely feedback to the Claims Director/Claims Manager regarding service failures, systemic issues or customer concerns
- Generate reports which are shared with the brokers to obtain necessary information required to finalize the claims/payment process.
- Assists in the completion of special projects.
- Attend and participate in meetings and trainings as required.
- Other duties as may be assigned.
MINIMUM QUALIFICATIONS
- Requires a high school diploma or its equivalent
- Related experience preferred.
- Fluent in English and Spanish.
- Confidentiality and time management skills.
- Ability to learn quickly and be self-motivated
This job description reflects management's assignment of essential functions and position responsibilities. Nothing in this job description restricts management's rights to assign or reassign duties and responsibilities to this job at any time.
WORKING CONDITIONS
The following job-related working conditions are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.
WORKING CONDITIONS
The following job-related working conditions are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.
Work Environment
The role primarily operates in an in-door, climate-controlled office setting working in close proximity to others. Noise level in the work environment is low to moderate. Light level provides adequate brightness for reading, computer work, and other tasks without causing glare or strain.
Physical Demands
The job primarily involves sedentary work with prolonged periods sitting at a desk. While performing the duties of this job, employees may occasionally be expected to:
- exert up to 10 pounds of force and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.
- operate standard office equipment such as copiers, computers, telephones, printers, etc.
Travel Requirements
Minimal to no travel required
NOTE
This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise.
The Company complies with employment regulations as they apply to the location of service.
