The Claims Processor will review and adjudicate medical, vision, dental, and short-term disability health claims and assist members with all claim related questions including verification of benefits.
Achieve productivity and quality guidelines set by Claims Manager.
Acquire and maintain a detailed working knowledge of assigned accounts.
Monitor claim inventory of assigned accounts and ensure turnaround and productivity benchmarks are met.
Review and adjudicate health benefit claims.
Communicate to Claims Manager any issues that would impede the accurate and timely review of claims.
Responsible for working pended claims reports for assigned accounts.
Provide customer service for all member calls and provide verification of benefits for all callers.
Responsible for notifying the Enrollment Department of any eligibility issues for necessary corrections.
Perform other duties as assigned.
Wellpath is an EOE/Minorities/Females/Vet/Disability Employer