CLAIMS SPECIALIST - LIBERTY ADVANTAGE

Liberty Health • Wilmington, NC

454d

About The Position

The Claims Specialist at Liberty Advantage is responsible for accurately processing department mail, handling premium payments, and auditing TPA claim files for accuracy. This role requires effective communication with various departments and a focus on improving workflow efficiencies while meeting deadlines.

Requirements

• High School diploma or equivalent required.
• Bachelor's degree in accounting or related field preferred but not required.
• Knowledge of Medicare and Medicaid programs preferred but not required.
• Exceptional interpersonal skills.
• Demonstrated ability to work independently as well as with a team.
• Proficiency in MS Office Suite.
• Exceptional organizational skills.
• Deadline driven.

Responsibilities

• Accurately process department mail and handle as needed.
• Deposit premium payments and other checks as directed once reviewed and approved for deposit.
• Provide rosters to NP's and others as directed each month.
• Review and audit TPA claim files sent for payment approval for accuracy.
• Check that contracts are accurately applied and various items are accurately reflected in the payments or denials of claims to providers.
• Work through the fax queue and address items as needed.
• Collaborate with other departments and TPA to maintain a positive flow of information.
• Evaluate tasks and prioritize based on deadlines and importance indicators.
• Continuously improve workflow efficiencies.
• Perform other duties as assigned.

Benefits

• Health insurance

What This Job Offers

• Job Type: Full-time
• Industry: Administrative and Support Services
• Education Level: High school or GED