Health Insurance Claims Representative

Job Summary

Responsible for maintaining control of all mail delivered from the mailroom by logging in each batch under the appropriate client code and delivering all batches to the correct areas that may not be scanned into AWD.  Completed batches are filed in Julian date order to be picked up for imaging.  Faxes and re-batches coming from the claim or customer service area are batched and delivered to designated individuals for processing.  Inventory reports are run daily and information is communicated to claim managers and supervisors, after logging completed claim information in Daily Operation Statistic and inventory tracking reports.  Supply orders are turned in and distributed by the Control Clerk

Primary Responsibilities: 

• Handle all transmittal claims or inquiries received from the mailroom, or via fax or correspondence, researching and resolving all discrepancies.
• Responsible for adding all mail counts received by the mailroom into an access database.
• Distribute all claims to the appropriate areas by client if not in AWD.
• File all completed batches in Julian date order to be picked up for imaging when applicable.
• Place calls to providers to obtain correct mailing addresses.
• Obtain and turn in weekly supply list to the main office.
• Email or distribute outstanding and complete batch reports to area managers daily.
• Input previous days completed claim information into Daily Operation Statistic reports.
• Track daily claims receipts by claim type in excel spreadsheet, to be reported monthly.
• Handle claim batch maintenance for QicLink Support.
• Actively participate in cross training to maximize team efficiency and maintain or exceed service standards. May include review of returned mail or eligibility claims.
• Assist with preparation of gathering documentation for internal/external requests, including client audits.
• Communicate openly with Supervisors, Managers and other team members to ensure accurate responses and to avoid duplication of efforts.

Primary Skills & Requirements:  

• Must understand the broad strategic concept of our business and link these to the day-to-day business functions of the mailroom, claim support, customer service and claim processing.
• Must be able to work scheduled shift and if needed, rotate schedules with other employees for proper departmental staffing needs and/or work overtime as needed. Because of the nature of the job function, punctuality and dependability are imperative.
• As needed, miscellaneous duties as assigned by team leaders, supervisors and management.
• Ability to understand mail batching process and display excellent research and filing skills when needed.
• Intermediate knowledge of Excel is essential. 
• Must have a clear understanding of the business procedures within the claims and customer service areas. 
• Good interpersonal and decision making skills required. 
• Good written and oral communication skills with ability to speak effectively and clearly in person and over the phone. 
• Must be organized and able to manage time effectively with all claim information from or to other departments. 
• Good PC application skills and typing to 30 wpm with accuracy and clarity of content. 
• Attention to detail and ability to listen / type simultaneously. 
• Must be able to exhibit flexibility in performing multiple functions.
• Team centered with excellent work ethic and reliability. 
• Honesty and respect for the company and its policies and procedures is required.
• High school diploma
• Must be local or residing in the nearby area

Schedule

• M-F
• 37 hours/week