Claims Processor III
Southern California Pipe Trades Administrative Corporation•Los Angeles, CA
•Onsite
About The Position
The Southern California Pipe Trades Administrative Corporation is seeking a Claims Processor in the Health & Welfare Benefit Funds Department. This is a Grade 3 union position that offers competitive pay as well as health and pension benefits.
Requirements
- High school diploma or GED.
- Experience with Microsoft Office including Word, Excel, and Outlook.
- Must be detail oriented and have strong organizational skills.
- Must have the ability to expedite work to meet deadlines with minimum supervision.
- Must maintain confidentiality of documents processed.
Nice To Haves
- Knowledge of medical terminology and coding preferred.
- Familiarity with Innovative Software Solutions Inc. (ISSI) and WEX platforms.
Responsibilities
- Review and resolve submitted claims by initiating payment or denial in line with eligibility and benefits as described in the applicable Summary Plan Description.
- Communicate with the appropriate party to obtain additional documentation where necessary.
- Provide proper and timely response to Member and provider inquiries on all non-complex claims.
- Review and resolve submitted claims through our HRA and WEX systems, ensuring that claims meet our guidelines before releasing payments.
- Other responsibilities will be assigned by Management based on the individual's abilities.
Benefits
- health and pension benefits
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
11-50 employees
