Claims Administrator

Description

SUMMARY: Receives and inputs new healthcare claims, processes payments, researches billing issues, and responds to email and telephone inquiries. Evaluates claims and administers payment, denies, or returns claims according to policy provisions and organizational guidelines. Produces routine and ad hoc reports.

Essential Duties and Responsibilities include the following: Other duties may be assigned.

• Prepare member reimbursement
• Electronic and outstanding issues.
• Convert appeals into electronic images
• Log, track, follow-up and distribute appeals electronically to examiners
• Provide administrative support to VP of Client Services and Claims Manager.
• Process subpoena for records requests
• Process itemized bills, track and log
• Maintain Claims Admin in MHB
• Perform other duties and responsibilities as assigned by Management

Supervisory Responsibilities : This job has no supervisory responsibilities.

Requirements

Knowledge, Skills, & Abilities:

• Strong computer skills, including Word, Excel, Outlook, and file database systems.
• Excellent written and verbal communication skills.
• Must be dependable and maintain excellent attendance and punctuality.
• Strong analytical skills and problem solving skills.
• Ability to grow with changing demands of the position and the company.
• Ability to work in a team environment.
• Ability to learn and use specified and sequenced processes that require specific information and step-by-step execution.
• Ability to use 10-key preferred.

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. 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.

Education and/or Experience: High school or G.E.D. equivalent; and minimum of two years of increasingly responsible office administrative, specialized administrative support or secretarial experience and/or training; or equivalent combination of education and experience.

Language Skills: Ability to read, speak, and write effectively in English. Ability to interpret documents such as safety rules, memos, letters, and forms. Ability to write routine reports and correspondence. Ability to speak effectively before customers or employees of organization. Ability to effectively address or resolve customer service issues within guidelines of the position.

Mathematical Skills: Ability to add and subtract, multiply and divide with 10's and 100's.

Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Certificates, Licenses, Registrations: n/a

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit for extended periods in front of a computer. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and use hands to finger, handle, or feel. The employee may frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. This position requires the employee to work in the office.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.