Senior Claims Processor in Wixom, MI at Beacon Health Options

Date Posted: 6/7/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic Senior Claims Processor to join our team in Wixom, MI! The Sr. Claims Processor will provide technical, training and scheduling support for Claims Processors.  Handle complex claim issues related to adjustments, refunds, returned checks and written provider/member inquires.  Act as liaison to other Beacon Departments and to providers. Ensure an even flow of claims processing by assisting the Claims Manager in reviewing claims received, coordinating inventory and reviewing suspended claims status. Handle the Claims Department’s complex issues related to adjustments, refunds, returned checks, voids, etc. Assist Claims Processors through training and monitoring.  Handle written inquiries from providers/members. Assist with auditing of the Claims Department staff.  Special projects and other duties, as assigned by Claims Department Director/Manager.

Position Responsibilities:

  • Interface with external and internal customers to resolve claim issues related to inquiries and adjustments in order to ensure optimal efficiency of service.  Respond to, written customer inquiries professionally and efficiently.  Generate letters to providers/members explaining claims action to ensure an understanding of the disposition of claims. Review and reprocess claims (make adjustments) for additional consideration.  Research claims for additional or missing information.
  • Ensure timely completion of adjustments, voids and refunds.  Initiate request for refunds by generating refund letters. Track collection from providers/members and follow-up accordingly.  Process returned checks and forward information to appropriate departments.
  • Train staff on equipment, systems and procedures and assist staff with on-going questions.  Function as, assist and train Claims Processors and Claims Auditors, when necessary.
  • Assist with the department auditing function.  Perform audits to ensure that Beacon policies and procedures are applied consistently and that claims are processed properly, accurately and timely.   Assist the Claims Manager in maintaining inventory levels.
  • Assist the Department Manager by generating and reviewing suspension reports to monitor status of suspended claims.  Review results with appropriate staff to ensure all claims are resolved and released.
  • Release claims for weekly check processing.
  • Apply Beacon policies and procedures consistently.  Maintain confidentiality of Clients Business Records and Reports. Maintain ethical and professional standards.  Maintain individual productivity and performance standards.  Meet Departmental expectations, accuracy, productivity, and performance standards.  Adhere to the components of the Compliance Program.   Ensure that job tasks are performed in a legal and ethical manner.  Actively assess work area for non-compliance issues and notifies supervisor or calls Ethics Hotline.  Adhere to compliance training requirements and understand that training is required condition of employment.   Complete tasks accurately within required timeframes.

Position Requirements:

  • Education: High School diploma or GED equivalent required
  • Relevant Work Experience: 3 years’ experience in computerized group health claims processing required
  • Knowledge, Skills, & Abilities:
    • Experience in Managed care setting preferred
    • Knowledge and experience using:
      • Management information systems (MHS, CAS, QNEX, DG, RIMS)
      • Word processing and spreadsheet applications (Microsoft Word and Excel)
      • Computerized claims systems
    • Ability to key with accuracy and pass a test of data entry skills
    • Strong customer service orientation and excellent verbal and written skills
    • Ability to interact with others and resolve problems

To Apply:

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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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