Medical Claims Processor Job Description Template
Our company is looking for a Medical Claims Processor to join our team.
Responsibilities:
- Conduct one-on-one training with new and existing clients;
- Handle all incoming calls quickly and efficiently while delivering quality customer service to the caller;
- Handle all incoming research and adjustment claims received from clients with resolution including portal requests, direct call and faxed requests;
- Responsible to provide claims reporting to Management and clients;
- Provides ideas to improve existing programs and monitors benefit administration;
- Other duties as assigned;
- Work claims reports and special projects as needed by Management;
- Ability to adjudicate claims in system as needed;
- Assist with on-boarding new clients to EHBA.
Requirements:
- Medi-Cal Experience;
- 2+ years TPA claims software system experience, preferably WLT software;
- Ability to work independently with minimal supervision, demonstrate self-motivation and willingness to learn;
- Ability to effectively communicate issues, recommendations, and findings both verbally and in writing;
- Excellent time management skills;
- Proficient with 10-key;
- Ability to work independently, take initiative, and problem solve;
- Understanding of Pharmacy/Medical terminology;
- Ability to make rational decisions while following pre-defined instructions;
- Must be detail oriented;
- HS Diploma or GED; some college preferred;
- Ability to work in a fast paced and productivity driven environment;
- Process 200+ claims per day;
- Experience on the insurance claims/ payer side;
- Knowledge of commercial insurance provisions, claim adjudication, benefit plan applications for HMO and Medicaid Plans.