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Medical Claims Expert
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Job Description

We are currently seeking a candidate for a Medical Claims Expert who will perform membership enrollment and termination eligibility verification as well as ensure that accurate, complete and timely information in accordance with Government regulations and the guidelines of the Membership Administration Department are available for processing.

Understands and maintains working knowledge of internal eligibility requirements for all lines of business.

Review and verify all applications and/or correspondence to ensure eligibility accuracy.

Track and monitor direct pay COBRA member eligibility.

Research, verify and process documents for all lines of business assuring adherence and compliance within Company's policies and procedures.

Coordinate/communicate with various departments, members and employer groups verbally and/or within

Access to provide and/or obtain information. Review and respond to inquiries and correspondence to follow-up with appropriate actions.

Calculate and determine outstanding balances that are due for IF members.

Responsible for mailing denial and/or incomplete letters to prospective IF members.

Retrieve daily census from hospital to properly input newborn information and to properly distribute the

information according to set guidelines and procedures.

Identify and rectify any eligibility problems within Membership's scope (merges, dual enrollments, etc.) Determine, group and mail out student certifications and letters based on the group and the status of the member.

Review monthly report to determine who should be terminated or not and act accordingly.

Receive and insert student information in the system.

Determine and send the correct newborn letters based on the member and group.

Perform all other related duties as directed.

Job Requirements

The ideal candidate will possess the following skills and qualifications:

Education - Prefer some college coursework - Will look at candidates with HS Diploma or GED Equivalent

Minimum Work Requirements

Basic Qualifications:

Two (2) years of clerical experience and knowledge of routine functions (i.e. form processing) required.

Two (2) years of eligibility verification experience in a health insurance industry required.

Preferred Work Experience - One (1) year experience working with federal and state regulations relating to enrollments and termination preferred.

Additional requirements

Ability to type 40 wpm required.

Proficiency in the use of applicable computer software required.

Effective interpersonal and communication skills required.

Job Snapshot

Employment Type Contractor
Job Type Admin - Clerical
Education Not Specified
Experience Not Specified
Manages Others No
Industry Healthcare - Health Services, Other Great Industries
Required Travel Not Specified
Job ID laATR100987
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Medical Claims Expert


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