Join the AMA Insurance team as a Claims Assistant. As part of the AMAI Claims team, you will validate eligibility and prepare claims not processed by AMAI for delivery to carriers. You will provide administrative and clerical support to the Claims Departments in order to maintain timely handling and processing of claims, claim checks and incoming claims mail.
Other Responsibilities will include:
Prepare claim documents for transmission to carriers for claims not processed by AMAI. Verify insured's eligibility and benefits, print certificates of coverage and screen prints from Administration system, accurately enter key information into each carrier's verification form and prepare daily transmittal for delivery to carriers.
Update the CAPS provider file with any new provider requests from the Claims Examiners within same day of receipt. Investigate provider mail items returned by the Post Office for correct mailing address. Terminate provider records with invalid addresses that are returned by the Post Office with a forwarding address and create new provider records reflecting the new address. Forward returned documents to correct address when practical. Process address change reports provided by vendors. Report monthly totals of returned and re-mailed to Claims Supervisor.
Review and process requests for check tracers for all claims checks for all carriers. Send emails to appropriate carriers and forward carrier responses to appropriate claims examiners for handling.
Pre-claim paper claims received. Correctly identify patients on CAPS Claims Adjudication System, select eligible plans, determine document type, date of service and flagging of high priority claims (those exceeding a specified dollar limit). Research unidentified mail/checks by researching CAPS and CAMS for related names and plans. Forward to the correct area for handling or return unidentified mail to sender with appropriate letter if no match is found.
Provide back up support to Distribution Assistants when necessary.
High school diploma required.
Prior data entry experience required.
Basic knowledge of insurance eligibility required.
Strong attention to detail and accuracy required.
Intermediate computer skills including Microsoft Office suite experience.
Motivation to independently complete work and deliver the desired outcome in line with job production and quality standards.
AMAI offers competitive salaries, including an incentive plan; excellent benefits and progressive technology. Our office is a business casual environment and we respect work-life balance. American Medical Association Insurance is located at 330 N. Wabash Avenue, Chicago, IL 60611 and is convenient to all public transportation in Chicago.
We are an equal opportunity employer, committed to diversity in our workforce. All qualified applicants will receive consideration for employment. As an EOE/AA employer, American Medical Association Insurance will not discriminate in its employment practices due to an applicant's race, color, religion, sex, age, national origin, sexual orientation, gender identity and veteran or disability status.
THE AMA IS COMMITTED TO IMPROVING THE HEALTH OF THE NATION
American Medical Association