The Claims Processor reports to the Regional Claims Manager, Employee Benefits Division. This position is responsible for registering, processing, and adjudicating claims accurately and efficiently.
Principal Duties and Responsibilities
- Process all claims for assigned group(s) within ten days of receipt.
- Complete forms for overspecific claims, including, but not limited to, printing EOBs, pulling claims and copying claims.
- Contact providers and case management company for information regarding problem claims.
- Print/mail EOBs and claim forms requested by providers and insured members.
- Assist with audits for assigned group.
- Assist with claims processing and overspecific for new or backlogged groups.
- Obtain needed information for subrogation claims and to determine pre-existing conditions.
- Perform other duties as assigned.
- Present a positive image of Consociate at all time.
- Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a customer, co-worker, producer or supervisor.
- Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
- Identify and perform work that has not been specifically assigned, as needed.
- Adhere to established safety standards and utilizes proper techniques to avoid work-related injuries.
- Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
- Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the Administration Division.
- Attend required in-service and staff meetings.
- Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees and applicants.
- Greets all people in a prompt and courteous manner. Communicates in a warm and courteous manner, making eye contact and speaking in a tone of voice that matches words.
- Ask customers what they need and strive to exceed their expectations. Offer and provide assistance whether or not the request falls within your specific job duties.
- Assists customers through the insurance submission/enrollment experience.
- Respond to customer requests in a timely manner, returning calls promptly and keeping them informed of delays before they ask.
- Makes decisions based on customer needs, opinions, complaints or suggestions.
- Takes appropriate steps to resolve problems to the customer’s or producer’s satisfaction.
- Ask customers for their opinions, accepting criticism as an opportunity to improve service.
- Seek opportunities, provide value-added services, and eliminate tasks that do not serve our customer.
- Remain aware of products and services provided by Dansig and Consociate.
- Project a positive, professional image when working.
Knowledge, Skills, and Ability Requirements
- High School Education required.
- Minimum of one to three years of experience working with the public. Previous insurance billing or customer service background recommended.
Physical and Mental Abilities
- Ability to perform sedentary work for extended periods of time.
- Ability to utilize personal computer (manual dexterity is required to operate a keyboard), telephone system, and communicate with a variety of customers.
- Ability to concentrate, meet deadlines, work on several projects during the same period, and adapt to interruptions.
- The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects during the same period, and adapt to interruptions.
- Reports to the Regional Claims Manager, Employee Benefits Division
- Work is performed in a normal office environment.
- There is minimal exposure to hazardous or unpleasant working conditions.
- Overtime as needed may be requested.
- Travel as needed may be requested.
As a Third Party Administrator of employee benefits, we are seeking talented individuals to join our team. We prefer candidates with previous experience, strong organizational, verbal, and written skills. Salary commensurate with experience. Benefits include paid time off, group medical, life, disability, dental, voluntary vision, flexible spending account, health savings account, and 401K with match.
Full job descriptions are available upon request. Consociate offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, and creates continuous learning and embraces the ideas and diversity of others. Please forward your resume to email@example.com
Consociate Health is an Equal Opportunity Employer