Claims Clerical Assistant

NFP•Spartanburg, SC

8d•$39,000 - $48,000

About The Position

The Claims & Clerical Assistant supports the Claims Department in processing Medical Stop Loss Insurance claims and provides essential clerical and administrative assistance to ensure smooth operations. This role is integral to maintaining ECU’s high standards for accuracy, compliance, and customer service.

Requirements

High school diploma or equivalent required.
Prior experience in insurance claims, medical billing, or clerical support is highly desirable.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
Strong organizational skills, attention to detail, and ability to manage multiple tasks in a fast-paced environment.
Excellent written and verbal communication skills.
Ability to work independently and collaboratively within a team.

Nice To Haves

Familiarity with Medical Stop Loss Insurance, ICD/CPT coding, and claims adjudication processes.
Experience working with TPAs, self-funded employer groups, or in a Managing General Underwriter setting.
Analytical abilities and problem-solving skills.

Responsibilities

Claims Processing Support:
Export claim data into the claims system.
Upload documentation, including high-dollar notices and monthly aggregate reports.
Log High-Dollar Trigger Notifications for review by senior staff.
Communicate with Third Party Administrators (TPAs) to request missing documentation.
Assist in the intake, review, and documentation of claims, ensuring all necessary information is collected and entered accurately.
Monitor claims for completeness, eligibility, and compliance with plan documents and stop loss policies.
Prepare and organize claim files, correspondence, and reports for Claims Auditors and Managers.
Support the Claims Team in appeals, audits, and special projects as directed by Claims Management.
Clerical & Administrative Duties:
Maintain accurate records of claims, correspondence, and reports in both physical and electronic formats.
Handle phone/email inquiries from clients, providers, and internal teams.
Prepare and distribute denial letters, explanations of reimbursement, and other communications as needed.
Assist with monthly and year-end reporting, including claims logs and reconciliation tasks.
Handle other administrative tasks as requested by management.
Customer Service:
Provide timely updates and support to claimants, brokers, and TPAs regarding claim status and requirements.
Ensure compliance with ECU’s policies, state regulations, and data privacy standards.