- Analyzing international claims to identify the claimant, type of services rendered and charge for each
- Accurately translate services identified on the foreign invoices as necessary.
- Obtain information necessary to properly act upon the claim and maintain appropriate written records of statements and facts relating to the claims.
- Input medical bills into the claims system in adherence to HTH/GeoBlue standards, determining benefits payable based on the customer's policy coverage provisions, initiating claim payments to providers and members.
- Maintain required departmental production and quality standards.
- Keep Manager advised of status of workload and identify problems for which help is needed.
- Follow regulations and company rules and policies as outlined in the Employee Manual.
- Other duties as assigned.
- High school diploma or equivalent required. Some college/degree a plus.
- Minimum – 3 years of experience in the health insurance industry examining and adjudicating medical claims. Prior exposure to international claims or specialty claim processing preferred.
- Familiarity with insurance products and insurance terminology, including CPT and ICD-10 coding. Coding Certificate desired for FEP (CPC, CCS).
- Ability to use automated claims adjudication software.
- Good verbal and written communication skills as well as strong interpersonal skills.
- Good analytical and organizational skills, as well as the ability to multitask and be detail oriented, with basic math skills.
- Ability to make decisions and support them with documentation.
- Knowledge of and the ability to learn Microsoft Office Products, Internal software systems, the internet and overall familiarity with personal computers is required, as well as the ability to work with dual computer monitors preferred.
- Flexibility in schedule is required.
- Employee is required to have at minimum an internet speed of 75 Mbps (standard high-speed internet access).
- Flexibility to work in an office and/or at-home, remote office environment.
- Overtime and/or schedule flexibility are occasionally necessary in this position. Individual may be required to attend key business/departmental meetings and/or perform certain business critical job functions outside of normal working hours.
- Physical Demands: Must be able to communicate internally and externally through receiving and responding to auditory and visual methods.
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Claims Analyst - King of Prussia, United States - Worldwide Insurance Services
Description
Job Description
Job DescriptionWe are hiring for Claims Analysts to join the team The Claims Analyst role analyzes international insurance claims to determine the type of services rendered. When processing Classic claims, this position determines the extent of insurance carrier's liability and settles claims in accordance with policy provision. Claims are to be handled in an accurate and timely manner while adhering to claim processing standards and Service Level Agreements.
Responsibilities:
Requirements:
Working Conditions:
Internal Pay Grade: 5
The starting pay for this role is $36,245 to $45,306 based on skill level and experience in a similar role.
This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned.
