Medical Claims Processor

GENERAL FUNCTION: Accurately and efficiently processes manual claims and other simple processes such as claims projects. Through demonstrated experience and knowledge, process standard, non-complex claims requiring a basic knowledge of claims adjudication.

MAJOR DUTIES & RESPONSIBILITIES:

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• Processing - Efficiently and accurately processes standard claims or adjustments
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• Consistently achieves key internals with respect to production, cycle time, and quality
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• May participate on non-complex special claims projects initiatives, including network efforts
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• Understands and quickly operationalizes processing changes resulting from new plans, benefit designs.
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• Drive client satisfaction - Works with supervisor and co-workers to provide strong customer service and communication with key customer interfaces that include Account Managers, Operations, Information Systems, Client Representatives and leadership team
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• Drives Key Performance Indications - Consistently meets or exceeds agreed upon performance standards in both productivity and accuracy
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• Proactively works with supervisor to develop self-remediation plan when standards are not being met
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