Reporting to: Supv, Operations
Researches and processes institutional and professional claims. Serves as a mentor to less experienced associates and acts as a resource to resolve more complex claims.
- Processes claims that pend for various hold reasons to assist in the final determination on claim disposition.
- Processes adjustments related to projects or provider disputes providing timely follow-up provider call backs.
- Researches complex claims issues and works with all external departments, markets, and providers on claims related content.
- Completes new hire audits.
- Runs and analyzes ad-hoc reports.
- Identify root-cause issues to ensure enterprise solutions and communicate findings as needed.
- Participates in all formal and informal training opportunities.
- Assists with special projects as assigned or directed.
- Arizona representatives may provide provider phone coverage two days a week
- Required A High School or GED
- Required 2 years of experience in Previous claims or health insurance (for external candidates)
- Required 6 months of experience in Institutional and / or professional claims
Licenses and Certifications:
- Intermediate Ability to communicate and make recommendations to upper management
- Intermediate Ability to multi-task
- Intermediate Ability to work independently
- Intermediate Ability to work in a fast paced environment with changing priorities
- Intermediate Demonstrated analytical skills
- Intermediate Demonstrated customer service skills
- Intermediate Demonstrated organizational skills
- Intermediate Demonstrated time management and priority setting skills
- Intermediate Demonstrated written communication skills
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Demonstrated problem solving skills
A license in one of the following is required:
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Excel