Medical Claims Specialist (on-site!)

Hiring for a Medical Claims Specialist for a company in Glastonbury, CT. Fully on-site position!

Monday thru Friday 11:30AM-8PM required hours. 
Pay: $23-24.50/hr based on experience 

MUST have recent 2 years+ medical claims experience!

Summary:
Responsible for working in a fast-paced environment and having strong interpersonal and communication skills, attention to details, outstanding ability to multi-task and prioritize, and strong analytical skills. Performs administrative tasks related to client health premiums and out of pocket medical expenses, interact with clients to provide information in response to inquiries about products and services, and handle and resolve complaints by performing the following duties.

Duties and Responsibilities:

• Processes or adjust medical insurance claims in accordance with policies and procedures.
• Answers phones and respond to client inquiries related to payments made on their behalf to medical providers.
• Answers phones and responds to medical provider inquiries related to payments made or due to their office on their behalf of program clients.
• Makes outgoing calls to medical providers and insurance companies.
• Responsible for having the ability to read explanation of benefits and healthcare terminology.
• Identifies, researches, resolves claim issues, and requests for additional documentation.
• Promotes teamwork and service delivery success.
• Ensures contractual performance guarantees related to payment processing timeliness and accuracy are met.
• Ensures contractual performance guarantees related to various means of client communications are met such as phone, email, and mail.
• Processes medical payments for clients.
• Assists in the client appeals process.
• Creates and updates financial batch records for processing by accounting.
• Audits payment files and outgoing payments and checks accuracy of figures calculation.
• Manages workflow for the team to ensure service levels are achieved.
• Manages call logs.
• Works with client’s that have high medical utilization.
• Recommends process improvements.
• Performs other duties as assigned.

Education/Experience:
Associate’s degree (A. A. / A. S.) or equivalent from two-year college or technical school; or two to four years related experience and/or training; or equivalent combination of education and experience.

Specialized Training:
Knowledge of medical insurance practices including enrollment, payment terms related to insurance premiums and out of pocket expenses, benefits coordination with other insurance coverage, and ensuring payer of last resort.

Certificates and Licenses:

• Medical coding/billing or insurance claims processing preferred

Knowledge, Skills, and Other Abilities:

• Speaking which includes talking to others to convey information effectively

• Knowledge of medical insurance practices including enrollment, payment terms related to insurance premiums and out of pocket expenses, benefits coordination with other insurance coverage, and ensuring payer of last resort
• Analytic Skills which includes the ability to review and understand payment and account history
• Active Listening which includes giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times
• Service Orientation which includes actively looking for ways to help people
• Proficiency with all MS Office applications including Microsoft Excel, Microsoft Word, and Microsoft Outlook