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Sr. Claims Processor - Medical

Expired Job

NTT Data Uniontown , OH 44685

Posted 2 weeks ago

Claims Examiner - Medical

Job Description

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.

REQUIRED:

  • Minimum Associates Degree
  • 3 to 5 years of current experience in processing medical claims.
  • Able to serve medical insurance plan members and medical providers by determining insurance coverage including eligibility and claim status; examining and resolving medical claims; documenting actions in the computer system; maintaining quality customer service; ensuring legal compliance.
  • Above average knowledge in claims adjustment / processing, financial software, documentation skills, data entry, analyzing information, problem solving, verbal and written communication, Customer Focus, general math skills and statistical analysis. Ability to work independently along with being organized and ability to multi-task.
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Sr. Claims Processor - Medical

Expired Job

NTT Data