Claims Examiner - Medical
FLSA Status: Non-Exempt
Reports to: Claims Supervisor
*NTT Data Services is assisting a healthcare TPA client with recruiting efforts. This is not a position with NTT Data Services.
GENERAL PURPOSE OF POSITION
The Claims Examiner is responsible for receiving and processing incoming calls involving benefits, eligibility issues and claims status. It is the responsibility of the Claims Examiner to process medical/dental claims for healthcare services in accordance with The Salvation Army benefit Health Plan provisions.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
1.Receive incoming calls regarding insurance coverage and benefits, eligibility issues along with claim status.
2.Answer and return phone calls and emails from The Salvation Army members each day. Return voice mail messages in accordance with organizational standards.
3.Accurately process medical / dental claims according to plan provisions, corporate policies and procedures.
4.Consistently meets production goals in accordance to organizational standards.
5.Communicate systems issues promptly to the Claims Supervisor/Manger.
6.Demonstrate a positive and cooperative work attitude, encourage teamwork among fellow employees and customers.
7.Provide backup in other areas, based on business needs with may include customer service unit.
8.Follow HIPAA guidelines, rules and regulations.
9.Other duties as assigned. Including assist supervisor/management with special requests.
May be called upon to perform other job tasks and/or project oriented work within skill level. In addition, may be cross-trained on select tasks for back-up purposes.
QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty listed above satisfactorily. Additionally, the requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.