What are the responsibilities and job description for the Claims Processor l position at ProCare Rx?
Job Details
Description
Primary Duties:
This position requires sitting, standing and occasional light to medium lifting.
Description
Primary Duties:
- Receive, analyze and process assigned claims by product (medical, dental, vision, FSA or HRA) and group. Ensure accurate processing based on benefit plan design and/or regulations.
- Evaluate underpayments, resolve non-payments and rejected claims. Follow through until the claim is completely resolved and check is issued.
- Create appropriate Explanation of Benefits or letter to provider for each claim.
- Identify and escalate claims for review or audit based on business rules.
- Ensure required documentation or reporting is completed timely and accurately.
- Answer incoming telephone calls related to claim processing, provider support and member benefit coverage options.
- Make outgoing calls to members and providers to obtain additional information as needed.
- Retrieve and sort mail, fax and email to ensure timely and accurate handling and response.
- Perform clerical functions including data entry, filing, and sorting, typing, organizing, and recording information.
- Train co-workers and new employees, as required.
- Perform various related duties as assigned.
- High school diploma or equivalent required, post high school education preferred.
- Minimum two years of experience as a medical claims processor, medical biller or a similar service position in the health care industry.
- Must be flexible with scheduled work hours.
- Must have strong customer service orientation and excellent communication skills, and the ability to work effectively with clients, medical providers and plan members.
- Proficient PC skills in Windows-based applications.
- Ability to be flexible and quickly adapt to the changing needs in the department.
- Must be highly organized with strong attention to detail.
- Must be dependable and demonstrate responsible work patterns.
- Must have a high level of professionalism and courtesy.
This position requires sitting, standing and occasional light to medium lifting.