Job Summary:
The Claims Processor is responsible for researching, resolving, and processing claims timely and accurately within the standard metrics.
Supervisory Responsibilities:
This position has no direct supervisory responsibilities.
Duties/Responsibilities:
- Process transactions assigned as per the defined standard operating procedure.
- Meet or exceed the production & quality accuracy target/goals assigned.
- Plans, prioritizes, organizes, and completes work to meet established objective.
- Ensure the compliance of the company's policies to cooperate with standards and procedures.
- Answer questions and resolve issues for consumers and clients timely and accurately.
- Perform other related duties as assigned.
Required Skills/Abilities:
- Typing skills and accuracy in keying data required.
- Should have strong analysis skills, including the ability to catch data that represents inaccurate/incomplete from the actuals.
- Should be good in logical reasoning and connect to the process to catch errors.
- Extensive knowledge of medical terminology with the ability to correctly read and assess medical documents.
- Basic cognitive skills that include language, math, and reasoning ability.
- Solid interpersonal skills with the ability to work with people with diverse backgrounds (both non-technical and highly technical users). Demonstrated ability to build and maintain business relationships internally and externally.
- Decision-Making Skills - Capable of arriving at the appropriate decisions after weighing the pros and cons of all the options.
- Excellent verbal and written communication skills in addition to be a good listener to give value to the opinion and suggestion of others. This includes ability to communicate with the customers if needed.
- Exceptional problem solving and solution driven skills with the ability to review problem, troubleshoot root cause issues and determine path to resolution.
- Strong attention to detail to handle the complex claims.
- Able to work effectively in a changing environment and be able to contribute innovative ideas.
- Excellent time management and organizational skills balancing multiple priorities.
- Self-starter, able to independently drive work.
Education and Experience:
- 1 year of experience in processing healthcare claims
- High school diploma or equivalent
Physical Requirements:
- Prolonged periods of sitting at a desk and working on a computer.