Claims Clerk 1

Under the direction of the Claims Operation Supervisor this position is responsible to perform clerical functions In accordance with internal guidelines. The Claims Clark will interact with other departments, clinical personnel, patients and outside providers in a professional and friendly manner, to create and maintain a positive relationship with our internal and external customers.

1.1 Fax and manually send Medical Records requests to providers (MEDREC'S).
1.2 Distribute and/or work daily correspondence and reject reports.
1.3 Update and maintain Sun Knowledge unidentified members and providers log.
1.4 Send manual letters to providers for claims that cannot be entered into the system.
1.5 Review and send member and provider denial letters daily.

1.6 Vendor Rejects:

• Included claims that the data entry vendor does not data enter. These claims are reviewed to determine if they should be entered or if they need to be sent back to the provider for corrected information.

1.7 Forward Reports:

• Claims forwarded by processor needing to be mailed.

1.8 Review Senior claim receive date report for date validation.

1.9 Research correspondence and process appropriately.

1.10 Data Entry of claims as needed.
1.11 Acknowledge PDRs routed by Claims Clerk 2.
1.12 Perform other duties as assigned.

Requirements:

8.1 High school diploma/certificate required.
8.2 Prior experience in the health care field preferred.
8.3 Must be able to communicate effectively, both written and verbal.
8.4 Ability to organize end prioritize workload and multi-task.
8.5 Proven ability to work with all matters of a confidential nature.
8.6 Ability to use correct punctuation, grammar and spelling.
8.7 Working knowledge and proficiency with Microsoft Office applications (Word, Excel, Outlook, etc.)

The pay range for this position at commencement of employment is expected to be reasonably between $21.00 and $24.71. However, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

Compensation: Between $21.00 and $24.71