Highmark Health Associate Claims Processor in Pittsburgh, Pennsylvania

Description

JOB SUMMARY

This job organizes, prepares, and resolves routine claims, providing validation, documentation, and efficient processing.

ESSENTIAL RESPONSIBILITIES

  • Enters incoming or suspended claims into appropriate computer databases.

  • Reviews and researches assigned claims by navigating multiple computer screens, accurately capturing the data necessary for processing.

  • Ensures that the proper benefits are applied to each claim by using the appropriate processes and procedures.

  • Completes, on a daily basis, all data entry required to document and communicate the status of claims.

  • Escalates non-routine or potential denied claims to more experienced claims processors or supervisor.

  • Learns from and leverages routine or repetitive transactions to continuously improve accuracy and efficiency

  • Meets or exceeds established goals for customer satisfaction and attendance.

  • Other duties as assigned or requested.

EDUCATION

Required

  • High School Diploma/GED

Substitutions

  • None

Preferred

  • None

EXPERIENCE

Required

  • 0 - 1 year of experience in a customer service or customer support role, usually in an office setting, call center, or phone support role

Preferred

  • None

SKILLS

  • Knowledge of computers and the ability to learn new and complex computer systems

  • Ability to remain focused and productive each day though tasks may be routine or repetitive

  • Ability to advance self to the next job level over time through a combination of formal classroom training, coaching, mentoring, and multiple cycles of on the job experience

  • Ability to recognize if required information to process a claim is missing or incomplete and takes appropriate action to obtain such information

  • Ability to understand medical terminology, medical acronyms, ICD-9 codes, and CPT codes

  • Ability to multi-task, understanding multiple products with multiple level of benefits within each product

  • Necessary mathematical skills and effective oral and written communication skills

LICENSES AND CERTIFICATIONS

Required

  • None

Preferred

  • None

LANGUAGE REQUIREMENT (Other than English)?

None

TRAVEL REQUIREMENT

None

PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS

Position Type

Office-Based

Office-Based Positions

An employee in this position works in an office environment. The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.

Teaches/Trains others regularly

Does Not Apply

Travels regularly from the office to various work sites or from site-to-site

Does Not Apply

Works primarily out-of-the office selling products/services (Sales employees)

Does Not Apply

Physical Work Site Required

Yes

Lifting: up to 10 pounds

Occasionally

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies

REQNUMBER: J131538

Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity