Process professional medical claims pended for manual adjudication in assigned Workflow roles. Accurately interpret benefit and policy provisions applicable to fully-insured group/individuals and self-funded clients. Review claim to determine coverage based on contract, provider status, and claims processing guidelines. Develop and deliver one-on-one training to others using Lean training techniques. Provide back-up claim data entry assistance.
Work Experience: Two years medical claims or health insurance experience or one year of PacificSource claims experience.
Education, Certificates, Licenses: High school diploma or equivalent required.
Knowledge: Ability to develop thorough understanding of PacificSource products, plan designs, provider/network relationships and health insurance terminology. Research skills and ability to evaluate claims in order to enter and process accurately. Preferred computer skills include keyboarding and 10-key proficiency, basic Microsoft Word and Excel. Ability to prioritize work and perform under time constraints with minimal direct supervision. Ability to develop Lean training materials and deliver claims training to others. Team player willing to collaborate and help others accomplish team objectives. A fundamental understanding of self-insured business is helpful.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.