Claims Processor

Job description

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 prefe...