Description

TITLE: Claims Representative
DEPARTMENT: Health Care Assistance Program
FLSA STATUS: Non-Exempt
REPORTS TO: HCAP Assistant Manager

SUMMARY

The Claims Representative is responsible for the accurate processing of all receipted provider claims. This includes claims data entry, maintaining moderate level of communication with internal and external customers on issues pertaining to claims and participating in follow-up efforts to obtain missing information necessary to process claims.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Provide general claims support by performing daily entry of claims data into the HCAP software (Indigent Healthcare Solutions – I.H.S.).
• Stamp date all receipted claims and scan into appropriate electronic repository.
• Accurately maintain all claim files for record keeping.
• Respond to telephone inquiries from internal and external customers which includes providing accurate information on status of submitted claims.
• Verify member coverages, benefit types and eligibility for providers.
• Provide exceptional customer service.
• Assist with efforts to contact providers in order to disseminate billing information needed to process active clients’ unpaid medical bills.
• Consistently meet established productivity, schedule adherence and quality standards.
• Track and report claim issues to leadership team for mitigation.
• Participate in rotational assignments when necessary in order to provide temporary support for office needs.
• Other duties and responsibilities as deemed necessary.

SUPERVISORY RESPONSIBILITIES

This job has no supervisory responsibilities.

MINIMUM QUALIFICATIONS

• High school diploma/GED required.
• 2-3 years of customer service experience.
• Ability to utilize multiple computer applications to accurately document claim information.

PREFERRED QUALIFICATIONS

• Working knowledge of I.H.S. software.

SKILLS AND KNOWLEDGE

• Moderate word processing database and spreadsheet skills required.
• Basic Email and Internet skills required.
• Excellent communication skills to perform active listening and exchange accurate information in a responsive, respectful manner.
• Strong attention to detail.
• Good time management and organizational skills.

CERTIFICATES, LICENSES, REGISTRATIONS

• Current Texas Driver's License.
• Remain insurable by the current insurance vendor of MCHD.

NOTE: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Demand Category:

Light Duty: Lifting 20 pounds maximum with frequent lifting and/or carrying of objects weighing up to 10 pounds.

Audio-Visual & licensing Demands:

• Vision (Avg)
• Color Discrimination
• Peripheral Vision
• Depth Perception
• Hearing (Avg)

Required License / Certification: Valid Driver's License

Specific Actions Required: In an eight hour day, this job may include:

• Standing/Walking: 1-4 Hours
• Sitting: 6-8 Hours
• Driving: Occasional

Work Environment: This job may include:

• Chemicals
• Cold
• Dampness
• Heat/Humidity
• Noise

Repetitive Motions: This job will include:

• Simple Grasping
• Fine Manipulation
• Pushing & Pulling
• Finger Dexterity
• Foot Movement

MANEUVERABILITY: This job will require: 

Frequent:

• Bending
• Reaching

Occasional: 

• Squatting
• Climbing
• Twisting

Qualifications

Salary : $18 - $29