Claims Processor I (Insurance)

Overview Perform claim processing for long term care (LTC) insurance claims and support the overall Long-Term Care Department. This work requires competent customer communication, evaluation of complex information, knowledge of insurance policies, and use of Long-Term Care Department operational procedure guides.

Job Details Claims Examination- Obtain all necessary information such as diagnosis codes, admit & discharge dates, and charges for services. Review claims for missing information and/or errors based on claim forms received and corresponding documentation (i.e. invoices, care notes, etc). Enter data per policy guidelines.

Know Existing and Upcoming Insurance Policies- Study and learn policy requirements across different products and different States.

Know and Understand Claims Processes and Procedures — Review Standard Operating Procedures to ensure clear knowledge of correct claims processing, calculations, data entry and document retention.

Communicate Complex Insurance-Related Information- Make phone calls to facilities for clarification regarding claims submissions. Report to and perform other work or projects as directed by the Claims Manager. Experience using mainframe computer and/or with PC applications such as MS Word or Outlook.

High school diploma, GED, or any combination of education, professional training, or work experience that demonstrates ability to do the job.

Previous Long Term Care (LTC) or other insurance claim processing experience.

Knowledge of medical terminology and coding such as ICD-10 diagnosis codes.

Medical Plans, including FSA and HSA

Dental and Vision

10 Paid Holidays and 1 Birthday Pay

College Tuition Reimbursement

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