Associate Claims Processor

Job ID: J126480
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Jun 26, 2018

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Description

JOB SUMMARY 

This job organizes, prepares, and resolves routine claims, providing validation, documentation, and efficient processing.

ESSENTIAL RESPONSIBILITIES 

  • Enters incoming or suspended claims into appropriate computer databases.
  • Reviews and researches assigned claims by navigating multiple computer screens, accurately capturing the data necessary for processing.
  • Ensures that the proper benefits are applied to each claim by using the appropriate processes and procedures.
  • Completes, on a daily basis, all data entry required to document and communicate the status of claims.
  • Escalates non-routine or potential denied claims to more experienced claims processors or supervisor.
  • Learns from and leverages routine or repetitive transactions to continuously improve accuracy and efficiency
  • Meets or exceeds established goals for customer satisfaction and attendance.
  • Other duties as assigned or requested.

EDUCATION

Required

  • High School Diploma/GED

Substitutions

  • None

Preferred

  • None

EXPERIENCE

Required

  • 0 - 1 year of experience in a customer service or customer support role, usually in an office setting, call center, or phone support role

Preferred

  • None

SKILLS

  • Knowledge of computers and the ability to learn new and complex computer systems
  • Ability to remain focused and productive each day though tasks may be routine or repetitive
  • Ability to advance self to the next job level over time through a combination of formal classroom training, coaching, mentoring, and multiple cycles of on the job experience
  • Ability to recognize if required information to process a claim is missing or incomplete and takes appropriate action to obtain such information
  • Ability to understand medical terminology, medical acronyms, ICD-9 codes, and CPT codes
  • Ability to multi-task, understanding multiple products with multiple level of benefits within each product
  • Necessary mathematical skills and effective oral and written communication skills

LICENSES AND CERTIFICATIONS

Required

  • None

Preferred

  • None

LANGUAGE REQUIREMENT (Other than English)?  

None

TRAVEL REQUIREMENT
None

PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
 

Position Type

Office-Based

Office-Based Positions

An employee in this position works in an office environment.  The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email).  The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks.  The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.

Teaches/Trains others regularly

Does Not Apply

Travels regularly from the office to various work sites or from site-to-site

Does Not Apply

Works primarily out-of-the office selling products/services (Sales employees)

Does Not Apply

Physical Work Site Required

Yes

Lifting: up to 10 pounds

Occasionally

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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