Evaluates and processes claims such as Diagnostic Testing, Wellness, Physician Expense, URM, GAP, Hospital Indemnity, Medlink, Dental, Triage/Incomplete or Pregnancy claims in accordance with Company policy terms, insurance laws, regulatory requirements and adjusting guidelines
Job Summary
Evaluates and processes claims such as Diagnostic Testing, Wellness, Physician Expense, URM, GAP, Hospital Indemnity, Medlink, Dental, Triage/Incomplete or Pregnancy claims in accordance with Company policy terms, insurance laws, regulatory requirements and adjusting guidelines.
Provides appropriate verbal and/or written communication to internal and external Customers in a positive and knowledgeable manner to ensure a high standard of Customer service.
Acts as a direct contact and communicates with Customers and medical providers in a positive, knowledgeable and professional manner, providing them with direction and assistance in all facets of insurance coverage and needs.
Matching Summary
Evaluates and processes claims such as Diagnostic Testing, Wellness, Physician Expense, URM, GAP, Hospital Indemnity, Medlink, Dental, Triage/Incomplete or Pregnancy claims in accordance with Company policy terms, insurance laws, regulatory requirements and adjusting guidelines.
Skills & Requirements
Must-have
Evaluate and process claims
Communicate with customers and providers
Adhere to company policy and guidelines
Provide positive customer service
Work in a paperless environment
Nice-to-have
Professional attitude
World-class customer service dedication
Teamwork ability
Key Requirements
High school diploma or GED
Good medical terminology preferred
General PC Windows-based software knowledge
Good understanding of anatomy and physiology
Good contract knowledge
Familiarity with CPT and ICD10 coding
Good analytical skills and judgment
Ability to be flexible in work schedule, including overtime