Icon hamburger
Briefcase

Create Job Alert.

Enter your email below to save this search and receive job recommendations for similar positions.
Thank you. We'll send jobs matching these to
No Thanks
US
What job do you want?
Apply to this job.
Think you're the perfect candidate?
Apply on company site

You’re being taken to an external site to apply.

Create an account to get recommended jobs that match your resume and apply to multiple jobs in seconds!
On the next page, you'll build a resume in 3 steps thanks to our AI technology
8-15 characters
Contains Number
Contains Lowercase
Contains Uppercase
Contains Special Character
Thumsup

You’re being taken to an external site to apply.

Enter your email below to receive job recommendations for similar positions.

You can apply faster when you're registered.

Default3

Claims Representative

Generis Tek Inc. Honolulu, HI Full-Time
Apply on company site

Create Job Alert.

Get similar jobs sent to your email

We have a Contract role Claims Representative with our client Memphis, TN. Please let me know if you or any of your friends would be interested in this position.


The details of the position are
Claims Representative-  Memphis, TN
Location         : Memphis, TN
Duration         : 07 Months contract  
Pay Rate        : $12.24 W2 Without Benefits.
 
Work Schedule: Mon - Fri 8am - 5pm
JOB SUMMARY:                   
  • The primary function/purpose of this job.
  • Verify member submitted claims forms, member's eligibility and pharmacy information is complete and accurate, updating system information as needed.
  • Superior data entry proficiency is expected in order to provide accurate and timely processing of claims submitted by member, pharmacy or appropriate agency.
  • Moderate knowledge of drugs and drug terminology used daily.
  • Process claims according to client specific guidelines while identifying claims requiring exception handling.
  • Navigate daily through several platforms to research and accurately finalize claim submissions.
  • Oral or written communication with internal departments, members, pharmacies or agencies to resolve claim issues.
  • Adhere to strict HIPAA regulations especially when communicating to others outside of Client.
  • Prioritize and coordinate influx of daily workload for claims processing, returned mail and out-going correspondence and e-mails to assure required turnaround time is met.
  • Assess accuracy of system adjudication and alert management of potential problems affecting the integrity of claim processing.
  • Analyze claims for potential fraud by member or pharmacy.
May be required to work on special projects for claims team.

ESSENTIAL FUNCTIONS:
The 6-10 major responsibility areas of the job. Weight: (%)
(Total = 100%)

1.Manage member and client expectations related to claim reimbursements. Input claim requests into adjudication platform maintaining compliance to performance guarantees, HIPAA guidelines and service standards, which include production and accuracy standards. Processing according to client guidelines making exceptions upon member appeal and client approval. Recognize and escalate appropriate system crises/problems and fraudulent claims to management. 40 %

2.Identify claims requiring additional research, navigate through appropriate system platforms to perform research and resolve issue or forward as appropriate 15 %

3.Research to define values for missing information not submitted with claim but required for processing. Identify drug form, type and strength to manually determine correct NDC number value which will allow claim to process. Continue researching values if system editing does not accept original assigned value. Utilize anchor platform, internet resources and/or contacting retail pharmacist as resources for missing values. 15 %

4.Initiate correspondence to members, pharmacies or other internal departments for missing information, claim denials or other claim issues. 15 %

5.Evaluate claim submission, ensure all required information is present and determine what action should be taken. Confirm patient eligibility and verify patient information matches system. Update member's address to match claim form if necessary. 5 %

6.Identify exception handling and process per client requirements. Monitor system to ensure client specific documentation related to claims processing and benefits is current and system editing is operating appropriately. 5 %

7.Variety of other miscellaneous duties as assigned 5 %

SCOPE OF JOB
Provide quantitative data reflecting the scope and impact of the job – such as budget managed, sales/revenues, profit, clients served, adjusted scripts, etc.
Maintain an average of 30 Commercial claims per hour (cph) or 35 Work Comp claims per hour (cph).

MINIMUM QUALIFICATIONS TO ENTER THE JOB:

Formal Education and/or Training:
High school diploma or equivalent required, some college or technical training preferred

Years of Experience:
Two years’ experience in P.B.M. environment is helpful but not required.

Licensures/Certifications:
n/a

Computer or Other Skills:
Strong data entry, 10-key skills, general PC skills and MS Office experience

Knowledge and Abilities:
• Strong data entry and 10-key skills
• Retail pharmacy, customer service experience helpful but not required
• PC and MS Office literate
• Strong attention to detail
• Excellent retention and judgment ability
• Proficient written and oral communication skills
• Ability to work in fast-paced, production environment
• Reliable, self-motivated with excellent attendance
• Team player who has the ability to stay on task with little supervision

 
If you are interested in this opportunity, please email your resume at [ Email address blocked ] - Click here to apply to Claims Representative and include posting 19-01729 in your application. Also, you can call us at #
630 576 1906
to discuss this position in detail.

About Generis Tek:
Generis Tek is a boutique IT/Professional staffing based in Chicagoland. We offer both Contingent Labor & Permanent placement services to several Fortune 500 clients Nationwide.
Our philosophy is based on delivering long-term value and build lasting relationships with our clients, consultants and employees. Our fundamental success lies in understanding our clients’ specific needs and working very closely with our consultants to create a right fit for both sides. We aspire to be our client’s most trusted business partner.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Recommended skills

Customer Service
Sales
Claims
Retailing
National Drug Code (Ndc)
Research
Apply to this job.
Think you're the perfect candidate?
Apply on company site

Help us improve CareerBuilder by providing feedback about this job: Report this job

Report this Job

Once a job has been reported, we will investigate it further. If you require a response, submit your question or concern to our Trust and Site Security Team

Job ID: 19-01729

CAREERBUILDER TIP

For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Learn more.

By applying to a job using CareerBuilder you are agreeing to comply with and be subject to the CareerBuilder Terms and Conditions for use of our website. To use our website, you must agree with the Terms and Conditions and both meet and comply with their provisions.