Claims Representative

TEKsystems•City of White Plains, NY

2d•$24 - $24•Onsite

About The Position

The role involves providing administrative support (primarily in the form of data entry). Duties in the job include transferring data using Microsoft excel and sorting it with intermediate functions. Candidates will require a degree of comfortability when it comes to math due to nature of the role and what they will be dealing with. Other duties include using spreadsheets to track customer information, organizing data, administrative support, data review for errors, and to provide data entry support as needed. Other duties as needed. Review and adjudicate all types of claims designated as “production claims”, meeting production and quality goals. Review, investigate, and apply all necessary criteria to determine validity of claim. Apply benefit plan rules and processing guidelines to pay, pend, or deny claims. Review and determine eligibility and coverage for specific group/plan. Research claim problems and take necessary actions to resolve. Utilize training and on-line documentation to keep up to date on processing guidelines, insurance principles, DOL rules and regulations, and benefit plan rules. Utilize Claim Workflow system for work assignments, routing, and follow up.

Requirements

Degree of comfortability with math.
Experience with Microsoft Excel.
Intermediate functions in Excel.
Ability to track customer information using spreadsheets.
Ability to organize data.
Ability to perform data review for errors.
Ability to meet production and quality goals.
Ability to determine validity of claim.
Ability to apply benefit plan rules and processing guidelines.
Ability to determine eligibility and coverage.
Ability to research claim problems and resolve them.
Ability to utilize training and on-line documentation.
Ability to keep up to date on processing guidelines, insurance principles, DOL rules and regulations, and benefit plan rules.
Ability to utilize Claim Workflow system for work assignments, routing, and follow up.

Responsibilities

Provide administrative support, primarily in the form of data entry.
Transfer data using Microsoft Excel and sort it with intermediate functions.
Use spreadsheets to track customer information.
Organize data.
Perform data review for errors.
Provide data entry support as needed.
Review and adjudicate all types of claims designated as “production claims”, meeting production and quality goals.
Review, investigate, and apply all necessary criteria to determine validity of claim.
Apply benefit plan rules and processing guidelines to pay, pend, or deny claims.
Review and determine eligibility and coverage for specific group/plan.
Research claim problems and take necessary actions to resolve.
Utilize training and on-line documentation to keep up to date on processing guidelines, insurance principles, DOL rules and regulations, and benefit plan rules.
Utilize Claim Workflow system for work assignments, routing, and follow up.