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Claims Associate at Other in Plymouth Meeting, Pennsylvania, US buy in US, Free Classifieds Ads

Job Description:

  • Review, research, solve and process assigned work. This would include navigating multiple computer systems and platforms (e. g. verify pricing, prior authorizations, applicable benefits)
  • Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes and procedures (e. g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/ certificates tool)
  • Independently complete on a daily basis all documentation and communicate the status of claims as needed adhering to all reporting requirements
  • Communicate through correspondence with members and providers regarding claim payment or required information, using clear, simple language to ensure understanding
  • Learn and leverage new systems and training resources to help apply claims processes/procedures appropriately (e. g. on-line training classes, coaches/mentors)
  • Meet and maintain the performance goals established for the position in the areas of quality, production and attendance

o Plan documents and plan benefits

o Interpretation of benefits

o Medical, dental, vision, behavioral health billing and claims adjudication

o FSA, HRA and HSA plans

Qualifications

  • An education level of at least a high school diploma or GED OR equivalent years of work experience
  • Proficiency with Windows PC applications, which includes the ability to navigate multiple programs and learn new and complex computer system applications.
  • Associates Preferred

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