Claims Processing Executive

Job Description

Responsibilities: • Analyze and evaluate workers's compensation claim payments using client proprietary software, systems and tools. Use payment documentation provided by payers to determine if the medical provider has been reimbursed in compliance with the applicable state workers compensation fee schedule and/or PPO contract. Research, request and acquire all pertinent medical records, implant manufacturers invoices and any other supporting documentation necessary and then submit with hospital claims to insurance companies to ensure prompt correct claims reimbursement. Conduct timely and thorough telephone follow-up with payers to ensure claims with supporting documentation have been received and facilitate prompt reimbursement. Prepare correct Workers Comp initial bill packet or appeal letter using Client systems tools and submit with all necessary supporting documentation to insurance companies. Other duties as required. Education: Diploma / Bachelors Degree in any discipline. Experience: • Experience working for a US based BPO OR US healthcare insurance industry experience OR a similar experience recommended. • Competent in MS Office Suite and Windows applications. Skills and Prerequisites: • Strong verbal communication skills. • Fast and accurate typing skills while maintaining a conversation. • Multitasking of data entry while conversing with Client contacts and insurance companies. • Ability to professionally and confidently communicate to outside parties via phone, email and fax. • Ability to handle large volumes of work while maintaining attention to detail. • Ability to work in a fast-paced environment. • Work under limited supervision, manage multiple tasks and prioritize assignments within limited time constraints. • Effectively communicate issues/problems and results that impact timelines for project completion. • Ability to interact professionally at multiple levels within the organization. • Timely and regular attendance.