Medical Claims Processor
Taft-Hartley Fund searching for a Health and Welfare team member. The Claims Processor provides excellent customer service to participants, providers, and vendors while processing routine medical, disability, HRA, and Death benefit claims according to plan guidelines and adhering to policies and regulatory requirements.
Responsibilities
- Be the first point of contact for participant and provider inquiries professionally and accurately respond to incoming calls explaining group benefits, confirming eligibility status.
- May provide customer service by responding to and documenting telephone, written, electronic, or in-person inquiries.
- Maintains current knowledge of assigned Plan(s) and effectively applies that knowledge in the payment of claims.
- Processes routine claims which could include medical, vision, prescription, subrogation, Disability, Life/AD&D, or stop-loss.
- Analyze medical procedures and diagnoses using HCPCs, CPT-4 and ICD-10 codes,
- Pay claims in accordance with plan design,
- Analyze billing errors to maintain customer support,
- Serve as member advocate with providers as needed
- Coordinate benefits with other plans, including Medicare.
- Maintain member confidentiality in accordance with HIPAA
Preferred Experience
- High School diploma or GED (required)
- Associate's Degree or Bachelor's Degree (Preferred)
- Excellent customer service skills are a must
- Knowledge of benefits claims adjudication principles and procedures, medical terminology, HCPCs, ICD-10 and CPT-4 codes.
- Ability to calculate figures and amounts such as discounts, interest, and percentages.
- Must be able to work in environment with shifting priorities and ability to handle a wide variety of activities and confidential matters with discretion
- Ability to communicate clearly and professionally, both verbally and in writing.
- Possess a strong work ethic and team player mentality with a highly developed sense of integrity and commitment to customer satisfaction.
- Computer proficiency including Microsoft Office tools and applications.
Job Type: Full-time
Pay: $22.00 - $33.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Application Question(s):
- This position requires answering phone calls and processing claims. Are you willing to balance phone calls with claim processing every day?
Experience:
- claim adjudication: 3 years (Preferred)
- disability claim processing: 1 year (Preferred)
- HRA claim processing: 1 year (Preferred)
- death benefit: 1 year (Preferred)
Work Location: In person
