Claims Processor

ProCare Rx • Southfield, MI

10h

About The Position

Primary Duties:  Receive, analyze and process assigned claims by product (medical, dental, vision, FSA or HRA) and group. Ensure accurate processing based on benefit plan design and/or regulations.  Evaluate underpayments, resolve non-payments and rejected claims. Follow through until the claim is completely resolved and check is issued.  Create appropriate Explanation of Benefits or letter to provider for each claim.  Identify and escalate claims for review or audit based on business rules.  Ensure required documentation or reporting is completed timely and accurately.  Answer incoming telephone calls related to claim processing, provider support and member benefit coverage options.  Make outgoing calls to members and providers to obtain additional information as needed.  Retrieve and sort mail, fax and email to ensure timely and accurate handling and response.  Perform clerical functions including data entry, filing, and sorting, typing, organizing, and recording information.  Train co-workers and new employees, as required.  Perform various related duties as assigned. Position Requirements:  High school diploma or equivalent required, post high school education preferred.  Minimum two years of experience as a medical claims processor, medical biller or a similar service position in the health care industry.  Must be flexible with scheduled work hours.  Must have strong customer service orientation and excellent communication skills, and the ability to work effectively with clients, medical providers and plan members.  Proficient PC skills in Windows-based applications.  Ability to be flexible and quickly adapt to the changing needs in the department.  Must be highly organized with strong attention to detail.  Must be dependable and demonstrate responsible work patterns.  Must have a high level of professionalism and courtesy.

Requirements

• High school diploma or equivalent required, post high school education preferred.
• Minimum two years of experience as a medical claims processor, medical biller or a similar service position in the health care industry.
• Must be flexible with scheduled work hours.
• Must have strong customer service orientation and excellent communication skills, and the ability to work effectively with clients, medical providers and plan members.
• Proficient PC skills in Windows-based applications.
• Ability to be flexible and quickly adapt to the changing needs in the department.
• Must be highly organized with strong attention to detail.
• Must be dependable and demonstrate responsible work patterns.
• Must have a high level of professionalism and courtesy.

Responsibilities

• Receive, analyze and process assigned claims by product (medical, dental, vision, FSA or HRA) and group. Ensure accurate processing based on benefit plan design and/or regulations.
• Evaluate underpayments, resolve non-payments and rejected claims. Follow through until the claim is completely resolved and check is issued.
• Create appropriate Explanation of Benefits or letter to provider for each claim.
• Identify and escalate claims for review or audit based on business rules.
• Ensure required documentation or reporting is completed timely and accurately.
• Answer incoming telephone calls related to claim processing, provider support and member benefit coverage options.
• Make outgoing calls to members and providers to obtain additional information as needed.
• Retrieve and sort mail, fax and email to ensure timely and accurate handling and response.
• Perform clerical functions including data entry, filing, and sorting, typing, organizing, and recording information.
• Train co-workers and new employees, as required.
• Perform various related duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED