Claims Coordinator

Summary

The Claims Coordinator will be responsible for medical, dental, and vision claims processing of claims submitted electronically or on hard copy. Each Coordinator will specialize in a Particular Client(s).

Excellent opportunity to get in on the ground floor of a company that includes employees as part of the team and delivers excellent wages and benefits.

GENERAL DUTIES AND RESPONSIBILITIES including but not limited to:

• Review claims for benefit determination based on work queue, electronic or hard copy submissions.
• Make corrections when necessary to incorrect Participant or Provider data when authorized.
• Assist Member Service Representatives with difficult claim issues.
• Primary responsibilities will not include telephone or personal interaction with participants or providers unless; it is determined by a supervisor or manager that assistance is needed in this area.

Requirements:

• 2-3 Years of Claims Processing experience
• Coordinator must be able to determine benefits for multiple groups and process claims accurately according to the corresponding Plan Documents.
• Coordinator will be expected to process X number of claims (based on Plan complexity) and maintain an accuracy rate of 98% procedure and 99% financial.
• Ability to read, write and speak Spanish is preferred, but not required
• Medical terminology classes, knowledge of medical billing and codes ICD9 and CPT coding is a plus.