Claims Clerk Job Description Sample
Excellence In Everything We Touch
Under direct supervision, performs a variety of claim clerical support duties for the Claim Department
Matches proper file and/or claim number on unidentified correspondence by use of the various automated systems for mail delivered by USPS/ACS/Unmatched mail queue in ODM.
Types a variety of material such as letters, benefit notices, or memorandums for medical appointment, attorneys, or external clients.
Performs control operator functions for various Service Center or Claim Office data systems.
Retrieves and/or re-files items from central storage facility and maintains accurate records of file activity.
Receives dock and messenger service deliveries and verifies accuracy of delivered material.
Prepares outgoing mail for shipment which includes the necessary attachments, wrapping, and sealing. This will include shipping/receiving computer equipment.
Performs a variety of clerical duties such as answering telephones, taking messages, dispersing faxes, making payments, sort/preparing files, and data entry.
Assists in updating jurisdictional notices and manuals used in the office.
Pulls files from storage for in-house state audits.
Prepares files in electronic form for state audits (payment history, file notes, and gathering medical reports).
Contacts agents and insured on routine claims to obtain coverage information or obtains through the various systems.
Issues payments, requests wage information for the adjusters, orders surveillance, and completes medical calls to obtain the current work status.
Schedules medical appointments and sends all appropriate correspondence relating to that appointment.
Performs other related work as required or requested.
Upholds the Crawford Code of Conduct
Must demonstrate basic knowledge of computer operations and of claim file systems and procedures.
2 yrs administrative experience preferred but not required.
High school diploma or GED; or the equivalent in related work experience.
Proficient in the Microsoft suite of products and like systems.
Must be capable of working in a fast paced environment
Must be flexible, adaptable, and have excellent multi-tasking skills
Must be technically proficient.
Excellent oral and written communication skills are essential.
Broadspire (www.choosebroadspire.com), a leading international third party administrator, provides risk management solutions designed to help clients improve their financial results. Broadspire offers casualty claim and medical management services to assist large organizations in achieving their unique goals, increasing employee productivity and reducing the cost of risk through professional expertise, technology and data analytics. As a Crawford Company, Broadspire is based Atlanta, Ga., with 85 locations throughout the United States. Services are offered by Crawford & Company under the Broadspire brand in Europe (www.Broadspire.eu), including the United Kingdom (www.BroadspireTPA.co.uk).
In addition to a competitive salary, Crawford offers you:
Career advancement potential locally, nationally and internationally. Crawford & Company has more than 700 locations in 70 countries;
On-going training opportunities through every stage of your career
Strong benefits package including matching 401k; health, dental, and life insurance; employee stock purchase plans; tuition reimbursement and so much more.
Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V
Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.
Claims Administrative Clerk
Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment – while still being valued for your individual strengths – Health Choice is the place for you.
Equal Opportunity Employer Minorities/Women/Veterans/Disabled
The Claims Administrative Clerk provides administrative and clerical support to the Claims Management Team and the Claims Department.
Assists Claims Management team with providing key performance information to Senior Management in order to ensure operational success:
- Organize and maintain files, maintains the Work in Progress (WIP) Report and the KPI report to measure processor success.
Data Entry of claims:
Log Inpatient Claims into claims database for purpose of ensuring timely filing.
Complete data entry of specialty claims as well as Form 1500 claims in a timely manner
Maintain and manage rejected claims and returns those claims back to the submitting provider in a timely manner:
Notifies providers when a claim is received for a non-Health Choice member
Prepare and distribute correspondence to provider and/or members for all lines of business
Maintain a log of HCA rejected claims
Report findings to department management
Assist with logging and tracking claims that are routed to external departments within the company:
Maintain and update Medical Review Log every day
Route pended medical claims to the Medical Review Nurse within two (2) days of pending date
Ensure completion of pends within ten (10) business days of pending date
Knowledge of medical terminology
Knowledge of ICD-9/ICD-10 (when applicable)
Knowledge of CPT Codes and HCPCs codes
Computer experience necessary, including utilizing10-key
Effective time management and organizational skills
Effective interpersonal and communication skills
File alphanumerically and chronologically
Read, write and orally communicate at a professional level
Work cooperatively, positively, and collaboratively in an interdisciplinary team
Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames
Must possess a strong ability in logic and interpretation
High School Diploma or equivalent GED preferred
Some college preferred in business or health care administration
At least two (2) years of secretarial and clerical experience in office environment
Disability Claims Clerk II
AmTrust North America, a Fortune 500 company, is looking for a disability claims clerk II for their office in Jersey City. The claims clerk II performs all clerical functions related to DBL Claims according to departmental methods and procedures.
Basic knowledge of Microsoft Office.
Minimum of two years clerical experience.
Typing and mathematical skills.
Excellent analytical skills.
Good verbal and written communication skills.
Good customer service skills.
Able to handle a large volume of work accurately.
Completes tasks within allotted time frame.
Ability to work independently without close supervision.
Monitor incoming faxes on Fax to Server.
Open mail, search, sort, prep, scan, index and route to the examiners inbox.
Prepare and index daily correspondence and route to the Examiners inbox.
Set-up new claim and route to the Examiners inbox.
New claim (DB450), search and verify coverage.
Type various letters and forms.
Input data on various logs.
Answer incoming calls.
Make call to Employer for policy number.
Prepare DB120.1 requests, scan, email or fax completed forms to the insureds
- Performs miscellaneous duties as necessary
Multiple concurrent tasks
Sitting or Standing
What we offer:
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Vacation and Holidays.
National Claims Support Clerk
Infinity Insurance Company is a leader in bringing specialized automobile insurance programs to the marketplace. We deliver innovative products and services that are designed to meet the diverse and evolving insurance needs of consumers.
When we named our company "Infinity" we knew it was a bold title. Infinity means without end. For more than 50 years, Infinity has done justice to its name, searching for every possible way to offer the best service. The key to our ongoing success is excellence. We strive for excellence in every detail, from our policy offerings and insurance products to our hiring and training programs. We don't take excellence for granted. All of our hard work has paid off. We consistently outperform the industry by making auto insurance more accessible, easier to understand and affordable.
ABOUT THIS POSITION
PURPOSE OF POSITION:
Assists callers with general questions about their claim or takes and forwards messages. Provides clerical support for the National Claims Department.
- Answers general customer inquires on claim procedures, provides adjuster name, payment status and other general information following specific guidelines. Information provided does not include information specific to a claim file investigation. Directs other customer inquiries to appropriate company personnel.
- Provides prompt, friendly, courteous and accurate service at all times. Enters notes in claim files or e-mails messages to company personnel as appropriate to the situation.
- Attempts to assist with and resolve complaint calls from customers whenever possible. Escalates calls to other claims personnel as needed to assist the customer.
The following duties are performed as assigned:
- Indexes mail to identify the correct claim number.
- Monitors Subrogation box requests in ICS and performs requested actions. Enters notes in the file to document actions.
- Identifies claim number, claimant and feature number for check copies forwarded from Accounting and enters data into ICS. Forwards attached documents to Subrogation, Salvage or Imaging as appropriate to the situation.
- Inputs data into ICS from pre-approved invoices to initiate payment to vendors.
- Completes accurate production reports on a daily basis for all items processed.
- Researches unmatched cash and recovery reports. Identifies reason for error and makes corrections as
needed. Notifies Accounting when changes need to be processed in that department.
- Completes projects as assigned.
- Researches company void/stop-pay checks returned by the insureds, attorneys or others to determine why returned. Consults with adjusters or management to determine whether to void or reissue the check. Enters correction in ICS as directed.
- Monitors the Florida Disclosure letter box in ICS and performs requested actions, including preparation of cover letters and sends to manager for review. Once approved and notarized, mails via certified mail to appropriate party. Enters notes into the file to document actions.
- Responsible for receipt and notification of adjusters when Time Demands are received.
- Prepares outgoing mail including notarized and certified mail.
- Monitors the PPP box for the PIP department in ICS. Performs requested actions. Enters notes into the file to document actions.
- Prepares documents to be mailed by either printing or saving to a CD as requested and sends to appropriate parties.
- PIFs fax reports received from ChoicePoint to the claim file and memos the adjuster.
- Performs other duties as assigned.
- Must have regular predictable attendance.
SPECIALIZED KNOWLEDGE AND/OR SKILL REQUIREMENTS:
1.Typing at 30 WPM with 95% accuracy required.
2.Must be familiar with operation of general office equipment including fax machine, copy machine, etc.
3.Good verbal and written communication skills in order to represent the Company in a professional manner.
4.Must be detail oriented and accurate and use good judgment in dealing with callers.
5.One year of clerical experience required. Customer service experience required.
6.Basic knowledge or Word or Excel.
Employees understand our commitment to a positive work environment and dedication to the utmost in service. Advancement opportunities include skill training and career paths for many positions. We take the time to get to know our customers and recognize the importance of building long-term relationships – with our business clients as well as our hardworking employees.
Come see why our team gets the job done right and has fun doing it!
Claims Clerk - Wausau, WI
Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.
The Claims Clerk is responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims.
Provide general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
Authorize the appropriate payment or refers claims to investigators for further review
Conduct data entry and re - work; analyzes and identifies trends and provides reports as necessary
Analyze and identify trends and provide reports as necessary
Consistently meet established productivity, schedule adherence, and quality standards
Recognize claims by determining claim type
- HCFA, Hospital, UB, and / or RX
Identify more complicated claims and refer them to Senior Claim Processor or Supervisor
Calculate other insurance and re - pricing benefits
Work claims files to ensure the appropriate eligibility and provider records are matched to the claim.
Updates and maintains claims tracking database
Limited work experience
Works on simple tasks using established procedures
Depends on others for guidance
Work is typically reviewed by others
High School Diploma / GED (or higher)
1 years of experience in an office setting environment using a computer as the primary instrument to perform job duties
1 years of experience managing with multiple tabs within Internet Explorer in a work environment
Ability to work 8:00 am
4:30 pm for training and 7:00 am
5:00 pm (8 hours) after training
Prior experience working with Medical Claims
Ability to type 60 WPM
Proficient with 10 key numeric pad data entry
Experience in production based environment
Understanding of Healthcare Claims including ICD-10 and CPT codes
Physical Requirements and Work Environment:
- Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of healthcare. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Keywords: customer service representative, customer service, CSR, UnitedHealth Group, call center, UnitedHealthcare, health care, office, phone support, claims clerks, Wausau,WI , medical claims , healthcare claims
Claims And Billing Clerk (Patient Account Coordinator)
BE A PART OF THE TEAM
We are seeking a highly motivated, detailed oriented, focused, professional indiviual for our billing and collections office.
Claims and Billing Clerk
A perfect opportunity for someone at entry level or with some previous experience in Billing or Administrative support in the medical field such as medical assistance, medical office, hospital worker, hospice, or nursing home.
Lincare is a dynamic, growing company with over 1,000 locations in 48 states. Lincare employs over 14,000 people who share our corporate vision for quality care and excellent service. Lincare offers competitive compensation and benefits.
At Lincare we believe that people create our success. Our primary goal is to hire and retain the best, most talented employees who are leaders in their own right and provide them with a growth environment that is focused on adding value for the customer. We strongly believe that the diversity of our employees and their ongoing growth and development, combined with our national footprint and a broad range of business activities, provide us with the ingredients required to maintain and grow our leading market positions around the US and Canada.
Claims and Billing Clerk – Customer Service
Medical Billing/Claims Clerk/Entry Level
Attends work on a regular and predictable basis
Contact payers for claims status, follow-up denials, or partial payments
Obtain payer requirements for timely adjudication of claims
File claims with appropriate documentation attached
Pursue, maintain, and communicate payor coverage/guideline changes/updates
Process all incoming and outgoing correspondence as assigned
Verify, adjust, and update Accounts Receivable (A/R) according to correspondence received from insurance company
Help facilitate interoffice communication on error and denial trends
Initiate the review/appeals process on disputed claims
Research credit balances and initiate refunds as required
Document all activity in customer's computer account
Answer Accounts Receivable phone inquiries
Work assigned RBCO reports
Available to assist other PACs with questions or collection needs
Acts as liaison between staff and management
Perform other duties as assigned
Claims and Billing Clerk – Customer Service
Medical Billing/Claims Clerk/Entry Level
High School Diploma or General Education Degree (GED) required
Knowledge of telephone etiquette and adequate oral and written communication skills
Shows effective problem solving, investigative and multi-tasking skills
Positive and cooperative attitude in working and communicating with individuals at all levels of the organization
Must be 18 years of age or older
Lincare offers excellent salaries, world-class benefits, and unparalleled opportunities for development - all to create an invigorating and satisfying environment.
Lincare is an equal opportunity employer, access and affirmative action employer. All qualified applicants will receive consideration for employment regardless of race, color, religion, creed, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Lincare provides reasonable accommodations for qualified individuals with disabilities. Because Lincare believes in providing a safe work environment, we conduct drug and background checks in our recruiting/hiring processes. AA/EOE, M/F/Disabled/Veterans
Lead Claims Data Entry Clerk
The Lead Claims Data Entry Clerk will oversee the daily management of the accurate and timely data entry of claims and all documents which include:
Keying claims for all lines of business, simple and complex
Reviewing eligibility when required
Distribution of work to the Data Entry Team
The Lead will work in conjunction with the Claims Production Supervisor to oversee that work assigned is completed timely and accurately while maintaining L.A CARE Health Plan's requirements with all State and Federal regulatory guidelines set forth.
The Lead will assist in the development of procedures and policies ensuring the achievement of goals and production standards established within the Claims Department while monitoring, identifying or reporting potential problems.
QUALIFICATION AND REQUIREMENTS
High School Diploma
With High School Diploma: 2 year history of accurate, high-volume claims data entry.
2+ years experience in healthcare claims.
Experience working in a Medi-Cal managed care environment.
Claims Appeals Clerk
Morgan Stephens represents the nation’s top healthcare systems offering the highest compensation and benefits to our top candidates. We are created and managed by experienced industry professionals in healthcare. As a leading provider of contract, contract to perm, and direct placement recruiting services to healthcare organizations throughout the United States, we have successfully served the needs of our employees and clients by placing thousands of quality healthcare professionals into organizations seeking top talent.
Exciting opportunity for career growth for a healthcare administrative professionals with any background in claims!
Details: printing letters, printing envelops, getting them stamped, making copies of the letter, and creating files for member compliance and appeals. Putting information into the system for documentation purposes and completing jobs that have a deadline.
Attention to detail
Ability to meet deadlines and work under pressure
Strong communication skills.
Professional clerical experience or data entry experience
35+ WPM score
Morgan Stephens ofrecemos reclutadores que hablan Espanol
Healthcare Claims Mailroom Clerk
Job Description:The Insurance/Healthcarejob family contains positions associated with providing consultancy utilizing knowledge and expertise on insurance and healthcare. Develops and implements general insurance and health policies in accordance with state and federal laws. Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions. Responds to provider appeals and meets with providers to resolve problems/issues. Provides directions for utilization review. Approves any remedial or recoupment actions associated with escalated claims. Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues related to insurance and healthcare programs.
- Participates productively as member of team, possibly in a team lead role.
- Completes complex tasks, assignments and defined processes with some level of independence.
- Multiple assignments worked and completed simultaneously as directed by leadership.
- Identifies, prioritizes and resolves most questions and issues independently. Answers questions of peers. Escalates more complex questions or issues appropriately.
- Complies with contract requirements, business unit rules and related industry and legal regulations
Education and Experience:
- High School Diploma or equivalent; may hold 2 year post-high school Degree
- Typically, 2-4 years of working experience in related fields.
Knowledge and Skills:
- Claims and healthcare knowledge preferrd
- Office administrative experience and skills.
- Ability to follow written policies, procedures and guidelines, and give feedback to leadership.
- Intermediate-level knowledge of operating systems.
- Self-motivated with good time management and organizational skills.
- Ability to read and interpret basic to moderately complex documents such as operating and maintenance instructions, procedure manuals, and government/healthcare guidelines.
- Excellent written and verbal communication skills and customer service skills, including professional telephone skills.
Life Claims Clerk (11462)
The claims clerk job is to receive and prep mail for the incontestable and contestable life claims units. Claims clerks are to make sure that the proper paper work is included in the received mail since different pieces of mail are needed to process a claim depending if it is incontestable or contestable. If the proper paper work is missing the claims clerk will request a systematic letter to request the needed information. The claims clerk also prepares follow up letters to the beneficiary. If no additional information is needed, the mail is sent to its respective department. The claims clerk also updates information in the system with regards to claim status. Claims clerks perform a variety of other functions which can include; match medical records to files, match contestable claim correspondence to files, working pending proof reports, follow up on all claim in suspense and follow up on reconciling items received from accounting.
Requests additional missing information to process claims.
Updates the system with current status of claims.
Matches medical records to files.
Matches contestable claim correspondence to files.
Researches all claims in suspense status.
Researches reconciling items received from Accounting.
Works pending proof reports.
Maintains production records of work performed and must meet the minimum production quotas set by the department.
Other duties; as requested by the supervisor.
Must be pc/Windows literate and posses a working knowledge of MS Office (Outlook, Excel and Word).
Data entry and 10-key skills by touch and sight.
High School Diploma or GED equivalent.
Job LocationOklahoma City, Oklahoma, United StatesPosition TypeFull-Time/Regular
Making better hires starts with building better job descriptions
- Browse 100s of templates across 40+ industries
- Customize your template with your company info & job requirements
- Post it to 20+ job boards in seconds – for FREE!