Job
Description
Job Summary The role of Claims Processor – Team lead is primarily responsible for overseeing daily activities of claims processing team. They perform and coordinate the claims and the processing unit efficiently for the clients of Virgin Pulse Healthcomp. This role oversees incoming claims from members and requires adherence to formal procedures, attention to details and technical proficiency. Essential Functions/Responsibilities/Duties Responsible for performing and maintaining workflow processes to meet client response times Interpret and apply policy and procedures for department Provide ongoing training for new and existing team members Align the daily operations of the Claims department with the strategic direction of the Company Serves as liaison between team members and the functional area management. Conduct and compile special analysis and reports of claim payment history of various types required for contracted compliance Review and understand plans, documents, and vendors. Identify and report to management any potential errors, problems, or issues regarding plan documents, claims processing and system setup. Direct client contact, internal staff, and vendor support to ensure customer and member satisfaction. Navigate and maintain a thorough knowledge of systems so that information can be researched and used to process claims. Understand and enforce company procedures, policies, and standards. Complete claims tasks in timely manner and maintain minimum production requirements for the number of claims processed per day Review and understand plan documents, medical documents, and eligibility information. Ensure proper system setup while processing claims. Identify, research, and resolve claims issues timely and accurately. Follow-up on inquiries that are not immediately resolved. Accept repetitive work tasks performed in a confined work area. Learn and retain a thorough working knowledge of all existing and new products and services related to claims processing. Discipline to work from home as business needs dictate. All other duties as assigned. Education And Experience High school diploma or equivalent required Some University or Post-secondary Education preferred Strong personal computer usage and Internet proficiency skills Ability to type 30 wpm minimum with accuracy CPC Certification Preferred 2+ years’ experience in Eldorado (HealthPac), QikLink or GIAS preferred Required Knowledge, Skills, And Abilities Experience in healthcare claims processing, preferably third-party administrator or insurance company setting. Proficiency in relevant software and claims processing systems preferred Excellent written and verbal communication skills Ability to adapt to changing priorities, workflows, and regulations in the healthcare industry. Collaborative attitude and willingness to work effectively in a team-oriented environment. Flexible with scheduling as business needs dictate Strong work ethic and self-starter, able to effectively manage multiple priorities and adapt to change within a fast-paced business environment Strong customer service, analytical and decision-making skills Must be able to learn quickly in a fast-paced environment Ability to organize and follow-up on multiple tasks/details with accuracy and timeliness Ability to effectively interact with employees at all levels of the organization and work with a variety of people from diverse backgrounds Ability to learn and navigate new software quickly Physical Requirements Must be able to remain in a stationary position 50% of the time. The person in this job needs to occasionally move about inside the office to access office machinery, filing cabinets and meeting facilities. Constantly operates a computer and other office productivity machinery, such as copy machine, computer printer, calculator, etc. Frequently positions self to maintain files in file cabinets. Frequently moves boxes or equipment weighing up to 25 pounds. Must communicate information and ideas so others understand. Must be able to exchange accurate information in these situations. Must be able to observe details at close range. Disclaimer This job description is not intended to contain a comprehensive list of activities, duties, or responsibilities, but constitutes a general description of the scope and function of the role within the company. Activities, duties, and responsibilities are subject to change at any time with or without notice. Show more Show less
