Claims Processor l

ProCare Rx Career•Southfield, MI

11d•Onsite

About The Position

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.

Requirements

High school diploma or equivalent required
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.

Nice To Haves

post high school education preferred

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.