Claims Examiner

Consociate Health, a leading Third-Party Administrator, offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, and creates continuous learning and embraces the ideas and diversity of others. As part of our Mission to make Healthcare more accessible and affordable for our clients through innovation solutions and expert consultation, we value the inherent qualities that are foremost in our Mission, Vision, Values- Compassion, Humility and Impact, which allow us all to create authentic relationships with our team and our clients. Position Summary: The Claims Examiner reports to the Regional Claims Manager, Employee Benefits Division. This position is responsible for registering, processing, and adjudicating claims accurately and efficiently. Principal Duties and Responsibilities : Process all claims for assigned group(s) within ten days of receipt. Complete forms for overspecific claims, including, but not limited to, printing EOBs, pulling claims and copying claims. Contact providers and case management company for information regarding problem claims. Print/mail EOBs and claim forms requested by providers and insured members. Assist with audits for assigned group. Assist with claims processing and overspecific for new or backlogged groups. Obtain needed information for subrogation claims and to determine pre-existing conditions. Perform other duties as assigned. General Expectations : Present a positive image of Consociate at all time. Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a customer, co-worker, producer or supervisor. Communicate in a clear and concise manner, while also demonstrating receptivity through active listening. Identify and perform work that has not been specifically assigned, as needed. Adhere to established safety standards and utilizes proper techniques to avoid work-related injuries. Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively. Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the Administration Division. Attend required in-service and staff meetings. Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees and applicants. Service Expectations : Greets all people in a prompt and courteous manner. Communicates in a warm and courteous manner, making eye contact and speaking in a tone of voice that matches words. Ask customers what they need and strive to exceed their expectations. Offer and provide assistance whether or not the request falls within your specific job duties. Assists customers through the insurance submission/enrollment experience. Respond to customer requests in a timely manner, returning calls promptly and keeping them informed of delays before they ask. Makes decisions based on customer needs, opinions, complaints or suggestions. Takes appropriate steps to resolve problems to the customer’s or producer’s satisfaction. Ask customers for their opinions, accepting criticism as an opportunity to improve service. Seek opportunities, provide value-added services, and eliminate tasks that do not serve our customer. Remain aware of products and services provided by Consociate. Project a positive, professional image when working. Knowledge, Skills and Ability Requirements : High School Education required. Minimum of one to three years of experience working with the public. Previous insurance billing or customer service background recommended. Physical and Mental Abilities : Ability to perform sedentary work for extended periods of time. Ability to utilize personal computer (manual dexterity is required to operate a keyboard), telephone system, and communicate with a variety of customers. Ability to concentrate, meet deadlines, work on several projects during the same period, and adapt to interruptions. The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects during the same period, and adapt to interruptions. Benefits: 401(k) 401(k) matching Dental insurance Disability insurance Employee assistance program Flexible spending account Health insurance Health savings account Life insurance Paid time off Paid training Vision insurance