Temporary Claims Examiner

Job Summary:
The incumbent in this position is responsible for quality and timely adjudication of claims (medical, accident, dental, disability, life, etc.). Must possess good written communication skills, be a detail oriented problem solver with good time management skills.

 

Essential Functions and Responsibilities:
1. Process claims in accordance with the plan document in a timely and accurate manner
2. Perform a detailed analysis of medical treatment submitted for payment
3. Investigate and administer the terms of coverage
4. Prepare High Dollar files for review from carriers
5. Prepare Appeals for review
6. Communicate with Policyholders, Claimants, Providers and Agents as required
7. Manage Individual mailbox according to company standards
8. Meet and/or exceed productivity standard of:
           > Minimum 300 production points per day
            > Goal 325 production points per day

            >Stretch 400 production points per day
9. Meet and/or exceed accuracy standard of:
            > Procedural 99%
            >Financial 99%
10. Maintain a working knowledge of State/Federal insurance regulations and mandates
11. Perform adjustments
12. Communicates issues, concerns etc. to supervisor
13. Maintain product/system knowledge
14. Adhere to deadlines/turn-around times
15. Respond to email inquiries from providers, agents, and claimants
16. Support the customer service team when required by answering incoming calls and providing issue resolution.
17. Serve as informational resource to other employees
18. Demonstrates the ability to comprehend and interpret documents, such as: training manuals, correspondence, brochures, cheat sheets etc.
19. Ability to multi task
20. Ability to handle special projects
21. Demonstrates a solid understanding of COB, Subrogation and HIPAA Privacy
22. Possess the ability to advise claims analyst on more complex claims issues

23. Follows workflow as approved by management
24. 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. 120

 

Employment Application

Download Employment Application

 

For more information contact us at human_resources@consolidatedhealthplan.com or call us at (413) 733-4540 ext. 120