Claims Representative

Role Overview

• Independently research and navigate various documents and databases to accurately process claims, ensuring compliance and adherence to established guidelines
• Confirm the presence of necessary documents within submitted claims
• Validate the accuracy of medical codes provided in claim submissions
• Assess the eligibility status of claims based on established criteria
• Review and verify other insurance coverage information in submitted claim
• Evaluate authorizations provided in claim submissions for accuracy
• Analyze account benefit plans to ensure claims align with coverage and policies
• Identify discrepancies, errors, or missing information
• Utilize multiple computer applications simultaneously
• Maintain self-discipline, consistently uphold a strong work ethic, and complete work tasks/responsibilities while working without close supervision
• Meet or exceed quality and productivity goals
• Identify claim processing learning opportunities by working directly with supervisors, coaches, and trainers to learn efficient and effective processing techniques and workflows
• Utilize a variety of virtual tools, including Outlook email, Cisco Webex, and similar applications, to effectively collaborate, communicate, and stay connected with colleagues and supervisors

Requirements

• High school diploma or equivalent
• Ability to quickly learn a variety of computer applications to complete job functions
• Experience sending/receiving emails, scheduling calendar appointments/sending invitations, attaching files in Microsoft Outlook
• Knowledge of basic Microsoft Excel functions, such as filtering/sorting
• Experience in navigating multiple computer applications through the use of shortcut keys and other techniques
• Detail-oriented with experience in applying complex policy/procedure documents
• Strong organizational skills to maximize available work time. Ability to prioritize tasks to ensure job tasks are completed before deadlines
• Proven experience completing work with quality and productivity performance standards
• Experience working independently in a virtual environment preferred
• Experience with medical and insurance terminology in a professional setting preferred
• Knowledge of CPT/ICD-10 codes preferred
• Proven experience in health insurance claims processing or similar field preferred

Benefits

• medical, vision, dental, and well-being and behavioral health programs
• 401(k)
• company paid life insurance
• tuition reimbursement
• minimum of 18 days of paid time off per year
• paid holidays