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Medical Claims Processor - Experience Required
Glastonbury, CT 06033 US
Claims - Healthcare Customer Service
Work for a growing Full-function 3rd Party Administrator that processes payments for thousands of individuals nationally. These volume transactions are associated with healthcare benefits, and medical payments that include deductibles and co-payments for medical and pharmaceutical claims.
Monday through Friday: 11:30am - 8:00pm with 2 days 9:30am to 6:00pm
Resolve client health premiums and out of pocket medical expenses by reviewing medical documentation and looking at gaps in medical documentation or records that could help with payment guidelines.
A representative list of duties:
- Answer phones and respond to client inquiries related to payments made on their behalf to insurers or medical providers.
- Make outgoing calls to clients, medical providers, insurance companies to resolve coding, payment, billing, and documentation clarification.
- Identify, research and resolve client issues.
- Ensure payment processing timeliness and accuracy are met.
- Send follow up letters approval and denial letters.
- Uses knowledge of Medicare, Medicaid and commercial insurance along with primary and secondary insurance claims.
- Process health and dental insurance premium payments for clients.
- Review payment files and outgoing payments for accuracy.
- Associate’s Degree preferred
- Experience with Medical Insurance including- Insurance follow up / Medical billing and payment / Billing resolution/ Insurance Claims
- Good understanding of Medicare, Medicaid, commercial insurance and secondary insurance
- Ability to read and understand missing Clinical Documentation, Clinical coding Enrollment; and Payment Terms related to insurance premiums and out of pocket expenses; Benefits Coordination with other insurance coverage.
- STRONG COMMUNICATION SKILLS–This is a highly interactive role . The chosen candidate will have experience with customer service, call center experience from an Insurance, billing or medical processing payment environment.
- Accurate documentation skills.
- Technology and Computer Skills: Proficiency with all MS Office applications (Excel, Word, Outlook, etc.) Billing and Insurance Software
- Prior Medical billing and payments or Medical Insurance Practices would be an ideal fit.