Claims Processor

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.