Participates in interview process for new employees for his/her team.
Provide new employees adequate training and monitor work progress.
Assist in writing or reviewing policies and procedures.
Serves as a mentor and knowledge resource for Claims Analysts and Technical Examiners. Meet with those employees to answer questions and discuss problems/concerns.
Assists with problem resolution related to the processing of claims assigned to his/her team.
Works with the Claims Team Leader and System Configuration staff to insure the correctness of system configuration for automated claims adjudication, as well as the establishment of appropriate manual processes when automation is limited.
Researches and resolves claims identified as 'miscellaneous mail.'
Ensures that 'urgent claims' are responded to within 48 hours.
Reviews all claims over dollar thresholds established for Claims Analysts and Technical Examiners.
Utilizes knowledge regarding contractual agreements between ASO clients and their health care providers; verifies correct payment of claims and capitation deductions.
Required to maintain knowledge and proficiency at performing job responsibilities of Claims Analyst and Technical Examiner positions.
Assumes responsibility for accuracy, timeliness and efficiency of working pended claims.
Identifies educational/training needs with regard to claims issues and shares with Team Leader.
Participates in task forces or committees established to deal with short-term or ongoing issues relating to claims.
The Senior Claims Analyst ensures accurate, timely and efficient processing of health care claims in compliance with state and federal statutes and contractual obligations. Serves as an expert resource for his/her claims team by assisting with day-to-day claims processing activities and projects.
Carle Foundation Hospital