Medical Claims Specialist
2 days ago
Job Summary
We are seeking a highly skilled Medical Claims Specialist to join our team at People Corporation. As a Medical Claims Specialist, you will play a critical role in processing group plan member health claims, responding to inquiries, and performing administrative duties.
Key Responsibilities
- Process group plan member health claims by applying established policies and procedures.
- Respond to written, electronic, or in-person inquiries related to claims, benefits payable, and general group plan policies.
- Perform other related administrative duties, including data entry, verification of eligibility, and claims payments.
- Liaise with medical professionals and provide accurate and timely information to members and clients.
- Verify eligibility of members, drugs, services, providers, co-insurance, deductibles, payments, and procedure/dental codes.
- Produce claims payments, including applying applicable deductibles.
- Interpret policies and administrative practices and correctly apply them in the adjudication of claims.
- Maintain electronic data and document systems, including scanning, faxing, filing, destroying, photocopying, and data entry.
- Verify work and data for accuracy and completion.
- Prioritize work to ensure effective time management.
- Maintain procedure manuals and document new procedures and updates.
Requirements
- A good vocabulary of medical terminology.
- Sound knowledge in the concept of group or individual benefits administration.
- Sound knowledge of Microsoft Office and standard office administration procedures.
- The demonstrated ability to learn and master new software and technology.
- The ability to extract and interpret or simplify information from various technical sources.
- Strong mathematical and organizational skills, the ability to prioritize and multi-task, and the ability to manage time effectively.
- The ability to adhere to existing company policies and procedures.
- The ability to use tact and discretion to maintain information in the strictest of confidence.
What We Offer
- Competitive compensation.
- Extended health care and dental benefits.
- A retirement savings plan with company contributions.
- A suite of Health & Wellness offerings.
- Mental Health programs and support for you and your family.
- Assistance for the completion of industry designations.
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