Claims Associate

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

The Claims Associate will key claims, handle incoming mail from various sources, upload and route work to the appropriate queues within the claims processing system. The Claims Associate is responsible for some of the pre-processing claims queues and will key Health Insurance Claim Forms (HCFA), Uniform Bill 04 (UB), Superbills, vision, and dental claims. This role will ensure that all necessary documentation is received in order to key claims and will reject documents received for individuals who are not Fund participants.

ESSENTIAL JOB FUNCTIONS AND DUTIES

Screens claims for completeness to insure all required information is received
Keys all claim types processed by the Fund
Adjudicates pre-processing claims according to established productivity and quality goals
Utilizes the claim processing system and the eligibility system to select patient information and route claims to the appropriate personnel for adjudication
Handles daily incoming hard copy documents, returned mail and electronic documents which includes opening, sorting, scanning & uploading images into the Javelina claim system for processing
Identifies documents sent to UHH in error and forwards to the PPO vendors for handling or if necessary returns to members and/or providers
Monitors inventory aging reports to insure claims are processed within time requirements. Processes claims on a first in, first out basis regardless of complexity or difficulty
Meets or exceeds established productivity and quality objectives
Responds to written inquiries sent to the Claims Mail email box when appropriate or forwards to the appropriate claims team for handling
Responds to Mailroom personnel questions regarding the Claims Department mail and advises how it should be handled
Demonstrates the Fund’s Diversity and Inclusion (D&I) principles in their conduct at work and contributes to a safe inclusive culture with equitable opportunities for success and career growth

ESSENTIAL QUALIFICATIONS

2 ~ 3 years of related experience minimum
Minimum of 1 year of healthcare and medical terminology experience preferred
Proficiency in medical terminology, ICD 10 and CPT coding, and experience or exposure to health claim processing is required
Experience with working an automated claim processing system is preferable
Prior experience in an office production environment with quality goals especially related to healthcare benefits administration is preferred
Prior experience with eligibility verification, coordination of benefits, medical provider selection, medical coding and subrogation is preferred

Salary range for this position: Hourly $17.49 - $21.38. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.

Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) as a flexible hybrid work-from-home arrangement. This means you are responsible for initial training in office, plus approx. one day a week in office, Oak Brook IL.

We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Pension, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).

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