Job Summary:
Assists employees, providers, and third-party administrators with eligibility and insurance claims filing processes. Reviews insurance claims, investigates and verifies eligibility, transmits routine claims and maintains records.
Job Duties:
Assists employees, providers, and third-party administrators with eligibility and insurance claims filing processes. Reviews insurance policy to determine coverage. Investigates and verifies claims eligibility. Provides follow up on insurance claims to ensure fair and appropriate resolutions to claims and to ensure claims are paid. Transmits routine claims for payment or advises claims supervisor if further investigation is indicated. Conducts and attends meetings and training as required. Maintains logs and files, tracks claims and payments. Reconciles payroll records to disability payments. Analyzes cause of injury and makes recommendations to loss prevention. Oversee and participates in the return to work program and bid presentations. Other duties may be assigned.
SUPERVISORY RESPONSIBILITIES
This position has no supervisory responsibility.
Qualifications:
EDUCATION REQUIREMENT
Associate's degree from two-year college or technical school in Business Administration or related field; or three years related experience and/or training; or equivalent combination of education and experience. May include two years or more of undergraduate college course work.
EXPERIENCE REQUIREMENT
An additional two years experience in a related business field is required. Prefer one year of experience in the insurance field.
CERTIFICATES, LICENSES, REGISTRATIONS
Must possess a valid driver's license with a driving history verified through a motor vehicle report that meets requirements for Cherokee Nation underwriting rating.
OTHER SKILLS AND ABILITIES
Employee must not and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG’s Cumulative Sanction Report, or the GSA’s List of Excluded Providers, or listed on the OIG’s List of Excluded Individuals/Entities (LEIE).
Must possess the skills to operate various computer programs and standard office equipment. Must be knowledgeable with word processing, spreadsheets, and graphic software; routine office equipment; must have excellent written and verbal communication skills.
PHYSICAL DEMANDS
While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and climb or balance. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, and the ability to adjust focus.
WORK ENVIRONMENT
While performing the duties of this job, the employee occasionally works in outside weather conditions. The noise level in the work environment is usually moderate.
