Claims Service Representative - TPA

Claims Services Representative

This Claims Services Representative requires an individual who has strong interpersonal and organizational skills, the ability to communicate effectively with a variety of personalities, multitask, problem solve and a willingness to adjust from a daily routine when necessary. The individual in this position will have a proactive, forward-thinking approach and a client service mindset. The primary responsibility of the Claims Services Representative is to provide first in class hospitality to internal and external clients, vendors and team members.

A Glimpse Into Your Day :

• Pulls and copies claims for quality assurance technician.
• Handles and resolves first level network, PC and equipment issues.
• Coordinates the internal scanning and retention of paper claims and other miscellaneous documents such as provider contracts, check work and appeals.
• Processes claims based on medical necessity decisions from KP.
• Uses scripts to pay / adjust large amount of claims very quickly, as needed.
• Runs and formats daily claim reports for internal and external review.
• Processes check run activities and distributes associated reports.
• Distributes reports to the Claims staff.
• Performs other projects, duties, and tasks, as assigned.

What Success Looks Like In This Role :

Why Choose Relation?

Relation Insurance Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Relation, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is presented within this posting.

You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.