General Summary
Performs a variety of duties related to the processing and paying of medical insurance claims. Communicates with claimants, providers and third party payors to answer questions and resolve problems. Enters/retrieves a variety of claims related data into/from computer, maintaining confidentiality. Pays, denies and/or excludes claims according to the plan document.
Shift
Part Time, Days, M-F 8-1
Duties and Responsibilities
Essential Functions:
- Sorts claims by category and enters appropriate information into computer.
- Adjudicates claims and makes payments, denials and/or exclusions according to the plan document.
- Reviews claim information for accuracy, completeness and consistency.
- Applies the appropriate coordination of benefits rules, investigates pre-existing conditions and subrogation, and
- determines appropriate level of benefits based on medical emergency criteria.
- Investigates processed claims in response to inquiries, questions and complaints from providers, claimants and third
- party payors.
Common Expectations:
- Maintains established policies and procedures, objectives, quality assessment and safety standards.
- Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through
- improvement and innovation
Qualifications
Minimum Education:
- High School Diploma or GED Required
Work Experience:
- Less than 1 year Relevant experience. Required
Courses and Training:
- Medical Terminology. Upon Hire Preferred
Knowledge, Skills, and Abilities:
- Basic computer skills.
- Good typing and communications skills.
Benefits Offered:
- Comprehensive health benefits
- Flexible spending and health savings accounts
- Retirement savings plan
- Paid time off (PTO)
- Short-term disability
- Education assistance
- Financial education and support, including DailyPay
- Wellness and Wellbeing programs
- Caregiver support via Wellthy
- Childcare referral service via Wellthy
#LI-HYBRID
- © MapTiler © OpenStreetMap contributors © Oracle CorporationTermsLegal Notices
- Use control and scroll to zoom the map
- Use two fingers to move the map
- 3550-3578 Concord Rd, York, PA, 17402, US
- Copy to Clipboard
Read Full Description