Claims Analyst Job in San Antonio, Texas Us
Reports to: Claims Manager Department: Claims Department
Date: November 2011 Classification: Salary
JOB SUMMARY:
Accurately examines and processes claims. Has a strong knowledge of group benefit plans, ICD9/CPT codes and medical terminology. Promote good customer service and present proper etiquette when dealing with callers and/or customers. Initiates a professional and courteous manner. Knowledge of involvement with company policies and procedures.
ESSENTIAL FUNCTIONS:
1.) Performs all functions and duties of the claims department to include back up to other analyst functions such as Flex accounts, dental and vision claims.
2.) Accurately and efficiently examines claims for processing to include diagnosis, procedure, plan benefits, and participating physicians.
3.) Assists insured members and providers with claim status and benefit coverage inquiries. This could be correspondence, customer service queue calls or visit from member to office.
4.) Receipt and distribution of incoming mail and faxes.
5.) Assists with filling to include member claims and correspondence.
6.) Assist with answering phones, as needed.
7.) Maintain client relationships with key personnel by coordinating all verifications with providers.
8.) Manage daily/weekly claims as required to meet set goals set by management to include communicating benefit claim coding errors or issues. This position requires individual to manage claims to ensure they are handled timely while adhering to quality.
ADDITIONAL RESPONSIBILITIES:
Performs other related duties as may be directed or requested by the Company Claim’s Manager or President.
JOB QUALIFICATIONS:
General office/clerical knowledge. Friendly personality with outstanding customer service skills. Strong oral and written communication skills. Experience working with confidential information.
KNOWLEDGE/SKILLS:
Must be able to type 50 wpm, use ten key and operate basic office machinery. Exercises a high degree of initiative, judgement, self managed/motivated and appropriate decision making. Excellent communication skills, both oral and written. Knowledge of group benefit plans, medical terminology and ICD9/CPT codes.
EDUCATION:
High School Diploma or Equivalent is required.
EXPERIENCE LEVEL:
Minimum of two-five years experience as a claims analyst experience in handling all claims to include professional claims, vision, dental and hospital claims in healthcare field.