Review of new documents
Sets up new claims in Ultera and CHESS claim systems.
Assignment of Eligibility Tasks to the appropriate claims examiner based on pre-determined criteria
Ability to identify complex diagnoses and to label these claims accordingly
Monitors and reports on new claim inventory levels
Able to meet production goals on a consistent basis
Ability to maintain a high level of accuracy and identify errors for correction
Can effectively communicate the claim status or request information from employees, employers, or doctors, and can accurately address any questions or concerns with confidence
Responds to all e-mail and phone inquiries within 24 hours
Responds to correction emails within required turnaround time
Handles various administrative functions including but not limited to; special mailings, filing, collating, faxing, printing files, etc.
Establishes excellent relationship with claim organization
May assist in special project work or other duties as defined by the needs of the business
Maintains high levels of customer service with internal and external customers
Willingness to cross-train on all Front End operations responsibilities
Requires critical thinking skills, high degree of accuracy, quality work products, ability to multi-task and maintain a high production pace and focus.
Requires a working knowledge of the company claim processing procedures and systems applications.
Must possess appropriate written and verbal communication skills to communicate with various departments.
The position responsibilities described above provide only a general outline of the duties of this role. As the position develops and changes with the needs of the business, you will be expected to adapt to the changes accordingly.
BS/BA degree preferred or equivalent work experience
Proficient with Lotus Notes, Windows and Microsoft application ( MS Excel, MS Word, MS Power Point)
Ability to work and solve problems independently
Must have a strong working knowledge of systems applications, and be comfortable using computers
Should be results oriented, be able learn quickly and make sound decisions after appropriate training
Ability to work independently or part of a team
Good communication (oral and written) skills
Time management skills is required We are committed to providing equal employment opportunities to all employees and applicants without regard to race, religion, color sex, national origin, citizenship status, age, sexual orientation, gender identity, marital status, uniform service member status, genetic information, disability, or any other protected status, in accordance with all applicable federal, state, and local laws. This practice extends to all aspects of our employment practices, including but not limited to, recruiting, hiring, firing, promoting, transferring, compensation, benefits, training, leaves of absence, and other terms and conditions of employment.