Job Description

Job Summary:

Responsible for the daily adjudication/review of medical, dental, vision, mental health and FSA claims. Claims may be auto-adjudicated or manually processed. Ensures claims are adjudicated accurately and in a timely manner. Keeps abreast of regulations, products and procedures. Maintains working relationships in order to serve as a liaison to outside sales staff, employers, administrators, plan members, providers and other insurance carriers. Contributes to department goals and objectives through claims processing efforts.

Minimal Acceptable Job Qualifications

Registration/Certification/Licensure:

N/A

Experience:

Two years claims processing or related experience.

Education:

High school graduate or equivalent (GED); additional course work beyond high school a plus

Job Knowledge & Skills:

Demonstrates working knowledge of the English language, verbal and written.Demonstrates working knowledge of general office procedures including organization of workload and       operation of basic office equipment; i.e., copy machine, fax, calculator, scanner and personal computer.Requires basic analytical, investigative and negotiating skills in order to review and resolve a claim.Demonstrates strong time management and organizational skills, as well as the ability to pay attention to detail relative to the processing of accurate and timely medical claims.

 

Equal Opportunity Employer