The Michigan Conference of Teamsters Welfare Fund has an immediate availability for a Claims Processor. This is an hourly, unionized position, represented by the Office and Professional Employees Union, Local 42. Essential functions of the position include, but are not limited to:
Process Medical Claims
· Review medical claims submitted electronically to ensure completeness and accuracy.
· Authorize claim for payment or reject payment and update the claim with the appropriate rejection code.
· Place in hold status any claim that requires review or correction.
· Update system to document status of claims sent to Blue Cross Blue Shield (BCBS) for reversal.
Process Dental Claims
· Return to Delta Dental or the provider those claims that cannot be processed by MCTWF staff.
· Update basys system to reflect that a participant and/or dependent is not eligible for coverage of claims for services covered by a work, auto, or third-party claim.
· Notify Benefit Recovery of update for pursuit of overpayment as appropriate.
Process Loss of Time (LOT) claims
· Review each submission for accuracy and updated information.
· Verify eligibility and perform system updates. Notify Benefit Recovery of changes in eligibility for pursuit of overpayment as appropriate.
· Review and update responses in basys to letters requesting additional information Monitor all incoming faxes for distribution to staff. Send claims to the appropriate area for processing.
· Process initial Total and Permanent Disability (TPD) claims in the basys system and maintain related files. Gather all necessary information and documents to process these claims.
· Complete various claim reports, such as 835 errors or open correspondence, on a regular cadence.
Perform other duties as assigned.
The successful candidate will possess the following skills and knowledge:
· High School diploma; Associate degree in related discipline preferred.
· A minimum of 2 years of experience processing medical, dental, and disability claims.
· Exceptional attention to detail.
· Ability to enter data into various electronic systems accurately.
· Familiarity with claims and billing software systems.
The successful candidate must live within a reasonable driving distance from the office located at 2700 Trumbull, Detroit, Michigan
While working a remote assignment, the successful candidate must have access to internet with sufficient speed and stability.
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Experience:
- Claims Processing: 2 years (Required)
- Medical, Dental Claims: 2 years (Required)
Ability to Commute:
- Detroit, MI 48216 (Required)
Ability to Relocate:
- Detroit, MI 48216: Relocate before starting work (Required)
Work Location: Hybrid remote in Detroit, MI 48216
