Duties Note: The following is not intended to be an exhaustive list of all duties required of this position.
ADA
E1. Processes claims under provisions of applicable contracts, provider operating agreements and corporate procedures through the performing of on-line transactions and /or adjustments utilizing the corporate claims administration system: •Identifies potential fraudulent cases and forwards to Special Investigations Department for further review. •Identifies opportunities to resolve issues on behalf of the customer, through process improvement requests. •Provides necessary documentation to management for recommendations on changes in departmental procedures/desk levels.
E2. Initiates correspondence and/or telephone contact incidental to general claims administration/adjustments and/or assignments. •Answers written and/or verbal inquires/correspondence from internal and/or external customers.
E3. Maintains accurate daily production records as needed.
E4. Maintains confidentiality and adheres to HIPAA regulations.
E5. Delivers service to internal and/or external customers in a professional, polite and efficient manner.
E6. Performs all job duties efficiently and at an acceptable rate of performance.
N7. Performs other duties of a similar nature that are necessary and not inconsistent with this position or pay grade.

Required Education:Required Experience:
HS/GED:Healthcare or insurance related experience; claims processing experience; knowledge of medical terminology

Preferred Education:Preferred Experience:
HS/GED:Preference given to candidates with previous claim processing or equivalent experience

Required Knowledge/Skills:
1. Must meet minimum qualifications to perform the job including satisfactory completion of all training and testing
2. Basic Computer Literacy test
3. Typing skills: 30 WPM
4. Job Content test
5. Ability to multitask in fast paced environment
6. Well organized with ability to adapt to changing office environment; exhibits attention to details and time management skills
7. Proficiency in English language skills, including spelling, punctuation and grammar, in both written and verbal communication to ensure communications are issued in a professional manner
8. Working knowledge of personal computer and application software such as Microsoft Office Suite.
9. Computer software typically used: Facets, PEGA and Content Manager
10. Ability to utilize basic office equipment including PC, telephone, copier, printer, fax, calculator
Required Licenses/Certifications:
Problem Solving
Identifies issues and problems; Identifies opportunities for improved claims processing
Managerial/Supervisory Responsibilities
Does this Position have Supervisory Responsibility? No
Number of Emps Supervised:
Titles of Employees Supervised:
Financial/Budgetary Responsibilities:
Other Job Specifications:
External Contacts: Providers, Customers
Working Conditions/Physical Demands:
Position requires:
* Must be able to work in an office environment
Position involves:
* Physical Effort: Minimum; typical of most office work. Mostly sedentary work.
* Weight: lift/carry/push/pull under 10 lbs.
* Prolonged Sitting
* Repetitive Motion
* Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)
* Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
* Vision Req: Close vision (clear vision at 20 inches or less)

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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