Job Details
- Responsible for accurate and timely handling of claim issues for all lines of business, including bi-directional sharing, FEP, Local and Commercial PA and AHNJ, BlueCard and Government market. Applies and maintains knowledge of claims processing and support systems.
- Research inquiries received from all areas, inclusive of internal and external sources (e.g. other plans, providers, legal, Sales); as required, perform member or provider payable claim payment adjustments when appropriate following the correct processing guidelines.
- Meet departmental quality and production requirements
- Respond professionally to internal and external inquiries, as appropriate, while maintaining corporate and departmental standards.
- Research claims that are paid incorrectly; recover overpaid and underpaid claim dollars from multiple sources and ensure all necessary transactional steps are taken to accurately process claim adjustments.
- Provide response to general questions within expected departmental standards of initial inquiry; provide daily feedback, status updates and targeted resolution dates for more complex issues.
- Complete special projects and participate in work groups as assigned.
- Perform other duties as necessary
Education High School graduate or equivalent work experience.
Experience 1 - 3 years proven work experience in a production environment.
Knowledge, Skills, AbilitiesDemonstrated math and comprehension skills required.
Good interpersonal skills for handling internal and external customers.
Well-developed listening, verbal and written communication skills.
Proficiency with Microsoft Office, specifically Excel and Word is required.
Ability to research and investigate information using multiple sources, operating systems and documented guidelines.
Must have strong organizational skills and problem solving ability.
Must be detail-oriented