Responsibilities:
Work with trainer and/or assigned co-worker to learn and perform review of plan documents and procedures to apply plan provisions, limitations and exclusions when making benefit determinations.
Learn to request information to complete or review claims using standard procedures and letters, and asks questions as needed.
Must demonstrate ability to learn and grow with continuous improvement and ability to increase average daily claim production while maintaining accuracy and quality.
Performs computations and processes claims independently up to the dollar threshold set by thetrainer not to exceed the job classification maximum of $1,500.00.
Learns to perform duties and prepare to become a Claims Examiner by meeting training objectives and expected production metrics.
Communicates efficiently by telephone, in writing or in person with all personnel, members, providers, external vendors or others regarding claim benefit questions or information.
Communicates with the Quality Assurance Supervisor in conjunction with their trainer as necessary to request and receive data on pending claims.
Learns to apply procedures to third-party liability claim claims.
Exercises professional judgment on daily tasks and seeks approval from supervisor or trainer when faced with new or unfamiliar tasks.
Maintain a 10 business-day turnaround time on assigned claim responsibilities.
Maintain and update a pending file with follow-ups on correspondence as required.
Ability to meet production and quality goals on a consistent basis as outlined within training.
Routes claims requiring review to the assigned Claim Adjuster Senior II.
Demonstrates knowledge of assigned duties as well as the legacy and the recently migrated claims processing system.
Perform other duties as assigned.
Minimum qualifications:
6 months or more within a Claims Pre-Processor position Or
6 months in another position with field related experience.
Working knowledge of basic office equipment.
Positive interpersonal communications with internal personnel, external clients and vendors.
Demonstrated ability to keep calm and positive within all communications.
Proven ability to accurately and timely review and edit documents.
Utilize computer, phone systems and reference materials to be able to effectively perform the essential functions of the position.
Previous experience utilizing Microsoft office software.
High school diploma or G.E.D
Preferred qualifications:
2 years of college experience in a related field.
Job Type: Full-time
Pay: $16.52 - $17.85 per hour
Benefits:
401(k)
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance
Schedule:
Monday to Friday
Work Location: In person
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