JOB
Under the direct supervision of the Chief Group Health Insurance, performs highly responsible health insurance work involving expediting the accurate and timely preparation and submission of insurance information both internally and to intermediaries. In addition, the employee answers related inquiries in accordance with established guidelines, relative to the respective insurance carrier.
Supervision received takes the form of conferences, memos and review of completed work. The Insurance Account Specialist is required to use good judgment initiative, safety and security controls to maintain good practices EXAMPLE OF DUTIES Maintains and controls insurance files for a specific account and enters data on the computer for insurance carrier and the Group Health Insurance office on a daily basis.
Prepares and submits claims to carriers and intermediaries after all information has been made available for billing.
Reviews files daily and spots checks bills, invoices and departmental documents for accuracy.
Sends correspondence to insurance carrier and other government agencies to ensure timely payment.
Prepares and submits a daily listing of all unbillable accounts.
Compiles monthly and annual claim statistics.
Reconciles payment information to be provided to and from the claims agent.
Verifies accuracy of payment information to be provided to claims agent.
Performs other related duties as required. SUPPLEMENTAL INFORMATION FACTOR 1 - KNOWLEDGE REQUIRED BY THE POSITION
Knowledge of Virgin Islands Code, rules and regulations, procedures and policies governing a group insurance plan.
Knowledge of insurance claims processing.
Knowledge of basic mathematics and use of a spread sheet.
Knowledge of filing practices and procedures.
Knowledge of Insurance office procedures. insurance representative and departmental guidelines.
Knowledge of the use of adding machines and/or calculators.
Skill in the use of personal computers and related software applications.
Ability to operate "on-line" input terminal equipment.
Ability to prepare accurate reports.
Ability to express oneself clearly and concisely orally and in writing.
Ability to deal tactfully with all persons contact during the course of work.
FACTOR 2 - SUPERVISORY CONTROLS
Direct supervision is exercised by the Chief or designee who gives specific work assignments and verifies work periodically.
Routine work is performed independently following set procedures; work is reviewed for accuracy and completeness.
FACTOR 3 GUIDELINES
Guidelines consist of established departmental rules, regulation, practices and procedures. Due to the recurring nature of the duties performed, instructions are easily memorized and little interpretation is necessary. When instructions do not apply, the problem is referred to the Chief or designee.
FACTOR 4 - COMPLEXITY
Work involves responsibility for preparation and submission of accurate and timely documents to department, claims agent and intermediaries. The incumbent responds to inquiries, prepares lists of claims and daily reports; usually the work is clear-cut and generally applies directly to the problem or issue at hand.
FACTOR 5 - SCOPE AND EFFECT
The purpose of the work is to facilitate the timely processing of insurance information so that covered individuals receive appropriate care and that payments reflect actual obligations.
FACTOR 6 - PERSONAL CONTACTS
Contacts are with co-workers, claims representatives, employers and intermediaries, and can be face to face, on the telephone or in writing.
FACTOR 7 - PURPOSE OF CONTACTS
The personal contacts involve exchange of information regarding claim filing procedures, billing addresses and other pertinent patient/employee related information.
FACTOR 8 - PHYSICAL DEMANDS
Work is mostly sedentary, however some walking, bending, and lifting is required to retrieve files and process paperwork.
FACTOR 9 - WORK ENVIRONMENT
Work is performed in an office setting.
