Claims Clerk 2

• Review and Route Provider Disputes/Reopening's daily.
• Review and Reconcile PDR/Acknowledgement letters.
• Research claims on the Potential Forward report and process according to the daily editing. Claims must meet the 10-day guideline.
  • Edits include but are not limited to; Eligibility issues, Behavioral Health, Health Plan Responsibility and claims with a FORW adjustment code.
• Review and input data from the Cap Deduct reports received monthly.
• Data enter claims for GSMS vision reimbursements for payment.
• Audit preparation as needed.
• Ability to perform all Claims Clerk 1 responsibilities as needed.
• Review and clear TransUnion rejections.
• Perform other duties as assigned.

• High school diploma/certificate required.
• Must know how to complete Claims Clerk 1 duties.
• Must be able to communicate effectively, both written and verbally.
• Ability to organize and prioritize workload and multi-task.
• Proven ability to work with all matters of a confidential nature.
• Ability to use correct punctuation, grammar and spelling.
• 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 between $22.24 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.