Claims Technical Advisor in Morrisville, NC at Beacon Health Options

Date Posted: 10/5/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic Claims Technical Advisor to join our team in Morrisville, NC or Latham, NY! The Claims Technical Advisor is responsible for providing technical support to the processing staff on a daily basis.  This includes managing the workflow to ensure client performance standards are met, including providing technical assistance to processors, identifying system related issues, providing feedback on audit errors, and performing remedial training.

Position Responsibilities:

  • Process complex professional and institutional claims or those claims that require additional research and resolution, including but not limited to, adjudication and/or adjustment of expedited/priority issues
  • Review and complete daily client reports under Claims Leadership direction
  • Work in collaboration with management to proactively identify client service improvement opportunities and resolve claims-related challenges
  • Contribute to a team environment by consistently exhibiting interpersonal skills, promoting a positive and motivating work environment, displaying flexibility with daily operations/functions
  • Assist with the facilitation of weekly operations conference calls and/or meetings
  • Run claims aging reports and route claims queues to claims processors, daily.  This includes examining queues to determine that work is assigned based on processor experience and account performance expectations for turnaround time   
  • Respond to processor adjudication and claims process questions throughout the day.  Advise processors on the calculation of complicated payment rates, payment of inpatient claims, etc.
  • Assist with new hire or refresher training as needed
  • Work closely with Claims Leadership team to ensure expedited/priority claims are assigned and adjudicated appropriately
  • Advise Claims Leadership of any policies and procedures needed to support the unit
  • Perform other job related duties as dictated by business needs, as determined by management
  • May be required to work additional hours when business needs dictate

Position Requirements:

  • Education: High School diploma or GED equivalent is required, Bachelor’s Degree is preferred
  • Relevant Work Experience: 2 years of claims processing experience in a health care or managed care environment required
  • Knowledge, Skills & Abilities:
    • Strong verbal and written communication skills required
    • Strong problem and analytical skills required
    • Ability to manage and mentor staff required

To Apply:

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled

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