Job Objective / Purpose
The Claim Processor will be responsible for the timely processing of medical claims based on the member’s health benefit program. S/he will analyze medical information, perform data entry, handle reimbursement claims, and decide whether a claim should be covered or denied and communicate issues or exceptions to other concerned departments as necessary.
This role will be hired under Flexicare HMO under Health Delivery System, Inc. (HDSI) - a subsidiary of RelianceUnited.
Duties and Responsibilities:
- Provide claims support by reviewing, researching, investigating, processing and adjudicating claims
- Authorize the appropriate payment or refer/escalate claims to concerned parties for further review.
- Adjudicate claims, analyze validity and identify trends and provide reports if necessary.
- Communicate any discrepancy of claims
- Consistently meets established productivity, schedule adherence and quality standards.
- Suggest any process improvement ideas to team lead that would greatly impact the process.
- Attend any developmental training for career and personal development.
Background and Qualifications:
- Candidate must possess at least a Bachelor's/College Degree preferably in health / medically-allied courses such as Nursing, Pharmacy, etc.
- At least 2 year(s) of solid working experience in the related field is required for this position.
- With experience working in TPA, HMO, insurance or insurance broker companies.
- Ability to work onsite and extend beyond company operating hours when needed.
- Strong attention to detail and accuracy.
- Outstanding communication (written and oral) and interpersonal skills, as well as excellent presentation skills.
- Familiar with health insurance / HMO policies and coverages.
- Exceptional critical thinking skills and is able to investigate root causes and recommend solutions.
- Strong organizational, multi-tasking and time-management skills.
- Proven ability to work independently and as a team member.
- Adheres consistently to the company values
Work Location: