Claims Assistant Jobs

About The Position

Requirements

• High school diploma or high school equivalency certificate.
• At least 6 months of mailroom, data entry, and clerical experience in a healthcare or managed care environment.
• Very detail-oriented, with the ability to count accurately and track claim documents throughout the mailroom process.
• Proficiency in Microsoft Excel, including the ability to create calculations and charts.
• Proficiency in Microsoft Word.
• Ability to work effectively within the mailroom and mentor and coach mailroom staff on correct procedures.

Responsibilities

• Open incoming mail and date stamp it.
• Sort and count mail receipts and claims.
• Scan paper claims and documents into electronic format, including scanning/OCR and verification against document images.
• Track claims receipts and inform the department manager of high volumes.
• Forward misdirected mail to the correct entity and route paper claims and nonstandard documents to Plan Partners and internal departments within required timeframes.
• Ensure incoming mail is counted, date stamped, and delivered to the correct party within 24 hours of receipt.
• Photocopy and mail correspondence to internal departments, Plan Partners, submitting providers, Participating Physician Groups (PPGs), members, and other parties.
• Dispose of mail and claims within 3 to 5 working days of receipt by the department.
• Maintain the departmental filing system and file claim-related information within seven working days; coordinate moving information to off-site storage.
• Answer phone inquiries, provide clerical assistance to the claims department, and order supplies.
• Determine workloads and process flows to ensure compliance with regulatory agencies.
• Mentor and coach mailroom staff on correct procedures.
• Perform other duties as assigned.

Benefits

• Medical, dental, and vision
• Wellness Program
• Paid Sick Leave