Junior Claims Processor

Junior Claims Processor

The Southern California Pipe Trades Administrative Corporation administers comprehensive benefits to members under the terms of the Collective Bargaining Agreements between Southern California Pipe Trades District Council #16 of the United Association of Journeyman and Apprentices of the Plumbing and Pipe Fitting Industry of the United States and Canada and Employers in the plumbing and pipefitting industry in Southern California. We are looking for a Junior Claims Processor for our Health & Welfare Benefits Department.

Experience & General Job Requirements:

• High school diploma or GED.
• Experience with Microsoft Office including Word, Excel, and Outlook.
• Must be detail-oriented and have strong organizational skills.
• Must have the ability to expedite work to meet deadlines with minimum supervision.
• Must maintain confidentiality of documents processed.
• Knowledge of Taft-Hartley employee benefit plans preferred.

Job Responsibilities:

Specific:

• Review and resolve participant repayment accounts, including determining amounts owed and issuing repayment notices through the WEX online benefits platform.
• Process ACH refunds and apply appropriate adjustments to applicable claims through the WEX online benefits platform, as needed.
• Review and resolve vision auto-adjudication claims, including approving claims and requesting additional information through the WEX online benefits platform.
• Place participant accounts on hold when necessary, until required information or documentation is received and reviewed.
• Other responsibilities may be assigned by Management based on the individual's abilities.

General:

• Communicate courteously and professionally by telephone, email, letter, and in person.
• Maintain current knowledge of Taft-Hartley benefits and other areas relevant to job duties through ongoing education and professional development.
• Maintain confidentiality in accordance with applicable law, regulations, and sound business practice.
• Maintain and update knowledge of current systems used in conjunction with job duties.
• Maintain and update knowledge of current processing rules and benefits. Other responsibilities will be assigned by Management based on the individual's abilities.

Notes:

• Background screening, educational verification and reference checks will be conducted on individuals offered employment.

The Southern California Pipe Trades Administrative Corporation is subject to the Los Angeles Fair Chance Initiative for Hiring Ordinance (FCIHO) (LAMC 189.00) and will consider for employment any qualified Applicants with criminal histories in a manner consistent with the requirements of FCIHO.