Imagine a career at one of the nation's most advanced health networks.

Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.

LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

Summary
The Group Health Claims Processor Associate supports the needs of the Group Health Claims Processor, Senior Claims Analyst, and Team Leads. As an entry level position, the Group Health Claims Processor Associate will pre-process medical claims to enhance production and efficiency of the Group Health Claims department while also learning the basics for reviewing and adjudicating claims according to health plan guidelines.

Job DutiesIdentify and resolve claims related to eligibility and provider identification pends. Adjudicate routine paper/electronic claims in accordance with established claims processing guidelines and handle claim status reports. Utilizes all applicable systems available to ensure accurate and timely claim processing. Determines and understands benefit coverage provided under a member's health plan. Meets all production and quality standards- total claim and pay dollar accuracy on both random and high dollar audits. Adheres to all procedures to ensure compliance with HIPAA standards and regulations. Responsible for working production related claim reports, including claim inventory and suspended claim. Update COB Screens based on member submission.
Minimum QualificationsHigh School Diploma/GED Less than 1 year no other experience required. Ability to work independently and with others in a fast-paced production-based environment. Basic computer skills, including Microsoft Office Suite. Ability to navigate computer applications. Ability to take feedback and direction. Ability to think logically and problem solve.
Physical Demands
Lift and carry 7 lbs., continuous sitting >67%, frequent keyboard use/repetitive motion, frequent fine motor activity/wrist position deviation.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.

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Lehigh Valley Health Network does not accept unsolicited agency resumes. Agencies should not forward resumes to our job aliases, our employees or any other organization location. Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes.

Work Shift:

Day Shift

Address:

707 Hamilton St

Primary Location:

One City Center

Position Type:

Onsite

Union:

Not Applicable

Work Schedule:

Monday-Friday; 8:00a-4:30p

Department:

1013-00043 Pop-Group Health Admin Services