Claims Specialist

Job Description

Job Summary As a Claims Specialist you will complete claim processing tasks and duties while performing best practices in time management, inventory, quality and procedures. Essential Functions/Responsibilities/Duties Maintain quality and procedure standards including compete review and examination of claim to ensure proper handling in accordance with company policies and procedures. Complete claims task in timely manner and maintain production requirement: Review and understand plans, documents and vendors. Ensure proper system setup while processing claims. Identify and report to management any potential errors, problems or issues regarding plan documents, claims processing or system setup. Work stop loss renewal process, as directed by management. Complete all training requirements in a timely manner, as directed by management. Understand and enforce company procedures, polices and standards. Practice good follow up procedures to ensure completion of task and/or inquiries. Direct client contact, internal staff and vendor support to ensure customer and member satisfaction. Support management team with projects and special requests. Education and Experience High School Diploma required Associate’s degree in business preferred 2 years claims processing 2+ years claims processing in the QicLink system preferred. Required Knowledge, Skills, and Abilities Must be able to establish and maintain good working relationship with clients and provide excellent customer service Must be computer literate and knowledgeable in Windows and Microsoft Office environment, including Word, Outlook and Excel. Knowledge of insurance database system a plus. Ability to work with others to accomplish mutual goals Healthcare industry experience strongly preferred, specifically in healthcare, health insurance, medical office or clinical experience at a front desk, in billing or admissions Remote work is possible depending on experience and business needs 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.