Claim Processor

Works with minimal supervision and is responsible for making an established range of decisions, escalating to Manager when necessary and updating Manager on a regular basis.

What you will do:

• Processes medical and flexible spending account claims of any type for multiple welfare plans according to established rules and guidelines.
• Coordinates claims with Medicare and other group insurance carriers. Must have working knowledge of rules established by Medicare for coordination of benefits and rules established by the (NAIC) National Association of Insurance Commissioners for other group insurance.
• Approves claim payments up to $4,000 on personal authority. Must be capable of detecting fraud or potential fraudulent claims.
• Maintains a working knowledge of medical terminology to interpret medical reports and bills to properly adjudicate claims. Keeps abreast of new medical procedures and terminology.
• Determines proper payees for benefits in order to discharge Company's liabilities.
• Maintains compliance with applicable federal and state laws (e.g., HIPAA) related to privacy, security, confidentiality, and protection of personal information, including, but not limited to, personal health information and personally identifiable information.
• Performs other duties as assigned
• Complies with all policies and standards

Qualifications:

• High School Diploma Or GED. (Required)
• Proven examples from work experience of maintaining a high degree of accuracy associated with high volumes of work and/or multiple duties. (Required)
• Demonstrated experience working effectively within a team. Must provide examples of motivating co-workers in difficult situations. (Required)
• Proven examples of consistently meeting productivity and quality goals from work experience. (Required)
• Experience must include identifying, defining and resolving problems, and collecting or interpreting data to establish facts, draw valid conclusions and provide solutions to problems. (Required)
• Demonstrated strong attention to detail with excellent organizational skills. Must cite examples of organization and time management methods used to manage or prioritize workload demands.
• Demonstrated excellent verbal and written communication skills with ability to convey information, verbally and in writing, to internal and external customers at all levels in a clear, accurate, focused and concise manner. Demonstrated ability to document procedures and activities in a manner that is understandable to others and prepared using a prescribed format. Verbal and written communications are to conform to proper rules of punctuation, grammar, diction and style.
• Proven ability to handle confidential information in a discreet manner.
• Working knowledge of word processing and spreadsheet applications.
• Demonstrated experience working independently to make decisions and demonstrate initiative.

Work Setting/Position Demands:

• Works in an office setting and remains continuously in a stationary position for long periods of time while working at a desk, on a computer or with other standard office equipment, or while in meetings. Performs continuous keyboarding work requiring the ability to make repetitive motions of the wrists, hands and/or fingers. Requires visual acuity to read a variety of correspondence, reports and forms and to prepare and analyze data in an accurate, neat and thorough manner.Extended hours required during peak workloads or special projects.

Travel Requirements:

• None