Descripción del trabajo

Location: Health Choice Management Co.
Posted Date: 4/17/2020
The Claims Lead assists the Supervisor(s) with daily operations. Monitors and assists a specific group of claims processors and provides first line technical contact for any claims related issues related to Health Choice claims. Responsible for coordinating work-flow, lead efforts in error reduction, and support team members with claim payment procedures. Will instruct others in processing procedures and/or provide general instruction related to claim adjudication. Reviews and applies the Plan policies and procedures as required for complex health benefit issues. Provides feedback to the supervisor(s) and trainer, through written and verbal documentation/communications, regarding claims issues, process improvements and other areas of concern.

Job responsibility:

  • Adjudicate and determine payment of claims to meet time frames determined by Health Choice, and respective contractual requirements.
  • Apply policies and procedures to confirm that claims meet criteria for payment and are in compliance with Health Choice, regulatory requirements, and respective contractual requirements
  • Provide assistance in the day-to-day operations of Claims Department and other job related duties as assigned.
  • Interface with Health Choice IS department and identify and participate in development of system modifications

Education:

  • High School Diploma or G.E.D. preferred
  • Some college in business or health care preferred

Experience:

  • At least three (3) years claims processing experience in CMS 1500, UB and electronic claims in a managed care environment
  • At least one (1) year processing claims on the Med/MC processing system preferred
  • At least one (1) year processing Medicaid claims

Instrucciones de aplicación

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