Associate, Claims Support Services
This role will be responsible for ensuring great member and provider experience by accurately and efficiently processing claims adjustments, while concentrating on putting our customers at the center of how Operations operates. Ensures accurate and timely processing of claim adjustments/service forms and ad-hoc projects/retro database items in accordance with medical and ancillary guidelines and benefits. Acts as a liaison with other department and outside vendors to resolve claim issues as they arise while also conducting root cause analysis on those issues with a focus on improving the member and provider experience. Completes daily reports as needed with flexibility to move from one project to another on a daily/weekly basis. Evaluates all business processes to proactively identify efficiency opportunities and partners with team leads to implement production and quality standards, identify trends and recognize process improvements with a focus on continuous improvement. Will work to reduce the number of complaints, appeals and DFS issues along with improvement in the average turnaround time and reduction in the number of hand-offs within the organization. Meets all departmental quality and financial goals. Keeps updated on job manual/process changes. Communicates directly with members and providers as needed. Supports a culture of continuous learning, support, and inclusion. Performs other related duties as assigned.
Minimum Education: High School Diploma required. Associates in Health, Business or related field preferred. Relevant work experience may be substituted.
Minimum Experience: Previous medical claims processing experience required. Knowledge of CPT, HCPCS, ICD-9-CM coding systems and medical terminology preferred.
Required Skills: • Strong Verbal and Written Communications • Critical Thinking and Problem Solving • Adaptability • Strong Time Management • Ability to sit at a computer for an extended period of time.
- Job Family Claims/Operations
- Pay Type Hourly
- Rochester Office, 220 Alexander Street, Rochester, New York, United States of America