Claims Specialist

Job Summary:
The incumbent in this position generally has insurance background, or claims paying experience and is responsible for the timely adjudication of claims (medical accident, dental, life, etc.) in support of the different product lines administered by Consolidated Health Plans.

Qualifications:

  • A minimum of one years’ work experience in the insurance field
  • Knowledge of medical billing codes preferred
  • Possess effective communication skills and be patient, resilient and stress tolerant
  • Cooperative and enjoy working with other as part of a team
  • Mature, responsible and dependable with focus on attention to detail
  • Above average computer proficiency skills with ability to type

Essential Functions and Responsibilities:

  • Learning the basics of insurance  
  • Understanding the products serviced at Consolidated Health Plans
  • Learning how to navigate the LuminX claim system
  • Understanding the claim adjudication process;
    • To process claims in accordance with the plan document in a timely and accurate manner.
    • Performing detailed analysis of medical treatment submitted for payment
    •  Investigation and administer the terms of coverage
    • Preparing High Dollar files for review from carriers
    • Communicate with Policyholders, Claimants, Providers and Agents as required
  • Manage Individual mailbox according to company standard
  • Meet and/or exceed productivity standard of:
    • Minimum 225 production points per day
    • Goal 275 production points
    • Stretch 400 production points per day
  • Meet and/or exceed accuracy standard of:
    • Procedural 98%
    • Financial 99%
  • Maintain a working knowledge of State/Federal insurance regulations and mandates
  • Maintain product/system knowledge Respond to email inquiries from providers and claimants
  • Demonstrates the ability to comprehend and interpret documents, such as training manuals, correspondence, brochures, policies etc.
  • Responds to customer service inquiry forms within 2 business days
  • Support the customer service team when required by answering incoming calls and providing issue resolution.
  • Demonstrates a solid understanding of COB, Subrogation and HIPAA Privacy
  • Follows workflow as approved by management
  • Communicates issues, concerns etc. to supervisor
  • Perform other duties as assigned, or as situations dictates 

 

Please send your resume and completed application to CHP Human Resources at:

Mail: Consolidated Health Plans, Human Resources, 2077 Roosevelt Avenue, Springfield, MA 01104-3503

Fax: (413) 452-5329 Attn. Human Resources

Email: human_resources@consolidatedhealthplan.com

Phone: (413) 733-4540 ext. 258

 

Employment Application

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For more information contact us at human_resources@consolidatedhealthplan.com or call us at (413) 733-4540 ext. 258