Senior Claims Processor in Woburn, MA at Beacon Health Options

Date Posted: 11/23/2019

Job Snapshot

Job Description

About the Position:

Beacon Health Options is currently seeking a dynamic Senior Claims Processor to join our team in Woburn, MA! The Senior Claims Processor is responsible for accurate and timely claims analysis completion through resolution of various projects. Provides assistance and guidance to Claims Specialists that requires a higher level of technical skills and knowledge. Responsible for working Claims tickets timely and effectively. Works with Accounts Management around complex provider claim complaints. Attends calls as needed.

Position Responsibilities:

  • Responsible for investigating and resolving claim related inquiries and other types of requests including but not limited to claim reprocessing and inquiries from internal and external sources.
  • Provides accurate and timely maintenance of the most complex provider and reimbursement information.
  • Analysis of provider’s trends and issues with reported findings 
  • Monitor, review and release of all claims batches in the Claims Management module in FlexCare. Includes: New, Queue, Pending and plan specific claims folders.
  • Ensures all applicable batches are released in time for weekly check runs.
  • Maintains thorough knowledge of the processing requirements for each Plan.
  • Review and process member reimbursements and checks refunds processingQuality check claim batches adhering to weekly check run deadline.
  • •Liaison with Mail Room team with claims related items.
  • Review and process specialty batches
  • Assist in post implementation process for new business.
  • Liaison for Member Services related to escalated claim calls
  • Create and maintain a manual documenting departmental tasks and assist with new hire trainings as needed. 
  • Working knowledge of vendor relationships (3M and other vendors as contracted)
  • Working knowledge of specialized pricing methodologies, I.E. 3M groupers – MS-DRG, APC, APGs, APR-DRGs.
  • Represent the Claims department on calls as needed.
  • Perform other duties as assigned.

Positon Requirements:

  • Education: High School / GED diploma required, Bachelor’s Degree preferred
  • Relevant Work Experience: 2 years’ of claims processing experience in a health care or managed care environment required
  • Knowledge, Skills, & Abilities:
    • Ability to handle demanding caseload
    • Ability to make independent decisions
    • Ability to multi-task

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

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.