Spec Claims Processor-23

What you will do

• This position is responsible for data entering all of the Medical, Dental, Hospital, Drug and Visions claims that are received each day for the Group Benefit Payment Offices and is performed independently. Modification of or deviation from procedures and practices is occasionally required. In this position, the entire claim submission must be reviewed quickly along with all attachments to enter information into an average between 75-150 fields per claim submission.
• The information must be entered extremely accurately and efficiently as there are very aggressive quality requirements and productivity target that must be obtained to meet the minimum requirements of the role. For a high percentage of claims, the Claim Processor will be the only person to see the claim submission. If the claim does not automate in the system, a Claims Examiner will use only the information the Claim Processor data entered onto the data entry system for final review/adjudication/payment of the claim. If errors are made in keying or by not following/interpreting the guideline information provided, the claims could be paid incorrectly resulting in overpayment or underpayment to the customers. As a result of services provided or actions taken, this could/would have a considerable impact on external client relations and the company.
• 80% Data entry, 20% misc. other duties
• Work independently to data enter a variety of health, dental, drug, hospital, and vision claims
• Review claim attachments and determine which data from this information is applicable
• Review complex claims with your team assistant and flag claims requiring further investigation
• Adhere to the changing requirements of our Health & Dental Claims policy job aids

What you will bring

More than 6 months and up to and including one year experience required