Job Summary:

• Serve as point of contact and subject matter expert for research and remediation of system
• Accumulator issues working with other departments to complete financial impact analysis.
• Responsible for monitoring changes related to accumulators, analyzing and researching.
• Responsible for communicating any changes needed to appropriate stakeholders and assisting with implementation of these changes.
• Function as a technical specialist for accumulators.
• Analyze complex operational problems and provide technical solutions.
• Identify and recommend areas where changes to existing processes and procedures can result in process and/or cost savings.
• Provide support to various IT staff.
• Identify key issues with projects and offer solutions.
• Identify accumulators that appear suspicious to management for further investigation

Skills on Resume: 

• Technical Expertise in Accumulators (Hard Skills)
• Analytical Skills (Hard Skills)
• Communication Skills (Soft Skills)
• Project Management (Hard Skills)
• Process Improvement (Hard Skills)
• Collaboration and Cross-Functional Teamwork (Soft Skills)
• Problem Solving (Hard Skills)
• Technical Support (Hard Skills)

Job Summary:

• Meeting or exceeding production and quality targets through defined key performance metrics (KPIs)
• Creating reports and analyzing data for trends
• Escalating issues and recommending corrective actions
• Demonstrating an intermediate to advanced knowledge of claims processing concepts, rules, and regulatory knowledge
• Participating in team activities such as huddles, team meetings, projects, and audit feedback
• Testing and monitoring of daily Fulfillment activities
• Delivery of new hire and/or ongoing training
• Maintaining and enhancing the Claims and Fulfillment knowledgebases
• Providing day-to-day support to associates including answering process questions, coaching of errors, issue research, basic technical troubleshooting, etc.
• Maintain and update required reference materials for accumulators.

Skills on Resume: 

• Analytical Skills for Data Reporting (Hard Skills)
• Problem-solving and Issue Escalation (Soft Skills)
• Knowledge in Claims Processing (Hard Skills)
• Team Collaboration and Participation (Soft Skills)
• Operational Testing and Monitoring (Hard Skills)
• Training and Development (Soft Skills)
• Knowledge Management (Hard Skills)
• Support and Coaching (Soft Skills)

Job Summary:

• Set up all claim assignments that come into the company. 
• Works for many different clients and there are different instructions on many of them. 
• Look through material sent in on a new claim and be able to pick out the correct information to set up the assignment. 
• Recorded telephone #s, claims #s, etc must be correct.
• Handle phone calls but answering the phone is not a predominant part of the job.
• Handle a high volume of emails coming in, both from clients and internal.
• Review adjuster claim reports, proofing, editing, and ensuring all is in order prior to bundling the report with enclosures and sending it off to clients within the claims program.
• Live in close enough proximity to Sandy Springs to be able to reliably report to work daily.
• Communicate clearly and professionally
• Assist in training other staff members.
• Assist in Dental Claim preparation

Skills on Resume: 

• Detail-Oriented Accuracy (Hard Skills)
• Multitasking and Prioritization (Soft Skills)
• Analytical Skills (Hard Skills)
• Proofreading and Editing (Hard Skills)
• Communication Skills (Soft Skills)
• Geographical Suitability (Soft Skills)
• Technical Proficiency (Hard Skills)
• Team Collaboration and Training (Soft Skills)

Job Summary:

• Resolving pended healthcare claims, prior approval requests and responding to providers.
• Analyzing claims to determine whether or not the claims should be approved or denied for payment.
• Reviewing and addressing provider inquiries regarding claim adjudication
• Meeting all required metrics for the position
• Applying knowledge of medical coding and various medical claims forms to the claims process.
• Process Dental Consultant claims following the instructions given by the Dental Consultant.
• Process pretreatment estimates following the instructions given by the Dental Consultant.
• Process information requests.
• Process assigned claim edit queues on a daily basis.
• Maintain patient confidentiality and adhere to HIPAA guidelines and requirements.
• Assist with the mail process

Skills on Resume: 

• Medical Claims Processing (Hard Skills)
• Analytical Skills (Hard Skills)
• Communication Skills (Soft Skills)
• Metric Achievement (Hard Skills)
• Medical Coding Knowledge (Hard Skills)
• Attention to Detail (Soft Skills)
• Administrative Skills (Hard Skills)
• HIPAA Compliance (Hard Skills)

Job Summary:

• Using PowerPoint Presentations, Adobe Captivate or other presentation methods.
• Develop and maintain training programs for Team Members, as well as corresponding support documentation.
• Identify areas of opportunity and formulate work plans in concert with management objectives. 
• Conducts training needs assessments.
• Research effective training delivery, including traditional classroom training, group activity, self-paced and One-on-One sessions.
• Analyze reports for the purpose of tracking and trending Team Member performance and identify opportunities for improvement.
• Assist in developing training materials by working with Claims staff, as well as Team Members from other departments within the organization, to develop training materials to improve existing training resources.
• Research and evaluate learning programs, trends, and practices in order to devise an appropriate curriculum.
• Explore opportunities to incorporate technologically advanced training software (Adobe Captivate) and web and computer-based programs to incorporate in the Claims training program.
• Maintain documentation including database updates, training agendas, sign-in sheets, etc. to demonstrate trainee compliance with department requirements.
• Work with the Claims Management Team to monitor error trends, productivity, and quality standards program for all trainees and Claims staff.

Skills on Resume: 

• Proficiency in Presentation Software (Hard Skills)
• Experience with Learning Management Systems (Hard Skills)
• Training Program Development (Hard Skills)
• Needs Assessment and Work Planning (Hard Skills)
• Training Delivery Methods (Hard Skills)
• Performance Analysis (Hard Skills)
• Collaboration and Communication (Soft Skills)
• Research and Innovation (Hard Skills)

Job Summary:

• Analyze complex operational accums problems and provide technical solutions. 
• Identify and recommend areas where changes to existing processes and procedures can result in process and/or cost savings. 
• Provide support to various IT staff.
• Identify key issues with projects and offer solutions.
• Identify accumulators that appear suspicious to management for further investigation
• Maintain and update required reference materials for accumulators.
• Processes incoming and outgoing mail daily.
• Queries and reviews all mail and new losses, then distributes them accordingly.
• Drop files and mail to files daily.
• Picks up and deliver faxes and outgoing mail.

Skills on Resume: 

• Analytical Skills (Hard Skills)
• Process Improvement (Hard Skills)
• Technical Support (Hard Skills)
• Problem-Solving (Hard Skills)
• Investigative Skills (Hard Skills)
• Documentation Management (Hard Skills)
• Mail Management (Hard Skills)
• Logistics Coordination (Hard Skills)

Job Summary:

• Scan, track and process complex claims, documents, and claims correspondence
• Process and ensure claims and correspondence are retrieved, sorted, logged, and scanned according to established procedures
• Maintain claims systems and research error reports to ensure quality and production standards are met
• Ensure claim counts are reconciled, discrepancies are resolved, and report unresolved issues to management
• Track postage use, process shipments, and prepare daily reports
• Monitor updates and changes to claims procedures and policies
• Act as a subject matter expert to the Claims Processor I staff
• Returns all files to the cabinets after Examiner/ Assistant uses them.
• Codes bills for payment and pay bills
• Pulls closed files for review.
• Obtains closed off-site files.
• Returns files to off-site location(s).

Skills on Resume: 

• Claims Processing (Hard Skills)
• Documentation Management (Hard Skills)
• Quality Assurance (Hard Skills)
• Problem Solving (Hard Skills)
• Logistics Management (Hard Skills)
• Policy and Procedure Adherence (Hard Skills)
• Subject Matter Expertise (Hard Skills)
• File Management (Hard Skills)

Job Summary:

• Print and reconcile all mail received via department e-mail and fax, ensuring all claims printed are clean and are forwarded to 3rd party processor daily
• Receives inbound customer service calls and answers claim questions in regards to claiming status, verification of eligibility/benefits, and claims payment. 
• Escalates more involved calls to the appropriate level of customer service.
• Monitors the team's voicemail and distributes calls to the team as necessary.
• Manually key HCFA and Dental claim to ensure accurate adjudication.
• Monitors and clears Pended claims
• Manually loads enrollments to Claims system for new companies
• Researches, drafts, emails, and indexes provider letters in response to charges billed to participants
• Performs other claims clerical functions by the Claims Manager.
• Type 10,000+ KSPH (alpha/numeric), in addition to being able to produce business correspondence required.

Skills on Resume: 

• Efficient Document Management (Hard Skills)
• Customer Service and Communication (Soft Skills)
• Problem-Solving and Escalation (Soft Skills)
• Team Coordination (Soft Skills)
• Data Entry and Claims Adjudication (Hard Skills)
• Claims Monitoring and Management (Hard Skills)
• Enrollment Processing (Hard Skills)
• Writing and Administrative Skills (Hard Skills)

Job Summary:

• Provide support functions to the claims department
• Sort incoming mail for distribution and dispatch outgoing mail
• Date, stamp, and sort mail according to established department policy and procedure
• Perform data entry functions
• Effectively manage workload and prioritize assignments
• Work without significant guidance
• Ensures claims inventory, outbound correspondence, and workflows are managed in accordance with State, Federal and Health plan regulatory requirements as well as departmental guidelines
• Securing titles, lien releases power of attorney and other required documents from lien holders and customers (first and third party).
• Issuing payments to lenders and customers, ensuring compliance and data integrity of electronic claim files, and processing salvage data.
• Interacting with internal and external customers and business-to-business contacts.
• Gaining customer loyalty through the delivery of exceptional service.
• Producing a high-quality work product in a high-volume work environment.
• Collaborating with team members and event owners.

Skills on Resume: 

• Organizational Skills (Soft Skills)
• Data Entry Proficiency (Hard Skills)
• Regulatory Compliance (Hard Skills)
• Time Management (Soft Skills)
• Independent Work Ethic (Soft Skills)
• Customer Service Excellence (Soft Skills)
• Attention to Detail (Soft Skills)
• Team Collaboration (Soft Skills)