Description
SHIFT: Day Job
SCHEDULE: Full-time
HRIS Title: CLAIMS PROCESSOR SR - Compass Source Job: Sr. Claims Processor Location: Michigan
Be part of an extraordinary team We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
About the Position: Beacon Health Options is seeking a Senior Claims Processor to join our team in Wixom, MI. The Senior Claims Processor will handle complex claim issues, act as liaison to other Departments and providers, assist Claims Processors through training and monitoring, assist with auditing of the Claims Department staff, and participate in special projects and other duties, as assigned.
Position Requirements:
Interface with external and internal customers to resolve claim issues related to inquiries and adjustments ensuring optimal efficiency of service. Respond to written customer inquiries professionally and efficiently. Generate letters to providers/members explaining claims action to foster and understanding of the disposition of claims. Review and reprocess claims (make adjustments) for additional consideration. Research claims for additional or missing information. Perform all duties of a Claims Processor, as needed
Ensure timely completion of adjustments, voids, and refunds. Initiate request for refunds by generating refund letters and/or debits on MHS. Track collection from providers/members and follow-up accordingly. Process returned checks and forward information to appropriate departments
Assist with the department auditing function. Perform audits to ensure that Value Options policies and procedures are applied consistently and that claims are processed properly, accurately, and timely. Assist the Claims Manager in maintain inventory levels. Assist with training staff on equipment, systems and procedures and assist staff with on-going questions. Function as, assist and train Claims Processors and Claims Auditors, when necessary
Assist the Department Manager by generating and reviewing suspension reports to monitor status of suspended claims. Review results with appropriate staff to ensure all claims are resolved and released
Investigate claims questions problems and complaints. Conduct research in order to analyze and correct problems. Recover overpayments. Reply to related correspondence
Contribute to overall success of the claims department in meeting performance guarantees to customers and maintaining customer standards. Ensure that established work processes are followed accordingly
Apply Beacon Health Options policies and procedures consistently. Maintain Confidentially of Clients, Business Records and Reports. Maintain ethical and professional standards. Maintain individual productivity and performance standards. Complete tasks accurately within required timeframes. Support Beacon Health Options in achieving Mission Statement. Adhere to the components of the Compliance Program. Ensure that job tasks are performed in a legal and ethical manner. Actively assess work area for non-compliance issues and notifies supervisor or calls Ethics Hotline. Adhere to compliance training requirements and understand that training is a required condition of employment. Participate in corporate and service center quality and utilization management programs, as appropriate.
Qualifications
Position Requirements:
Education: High school diploma/GED required
Relevant Work Experience: 3 years' experience in health care claims processing required, experience in a managed care setting using management information systems and software preferred
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state, and local laws.
Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.
REQNUMBER: PS71539-US
