- Demonstrates telephone customer service skills and empathizes with customers and claimants.
- Organizes and prioritizes work to assure accuracy and productivity targets are met.
- Effectively works independently and as a team.
- Documents and preserves all verbal and written communication in the claims system.
- Establishes and maintains accurate loss and expense reserves.
- Conducts investigation into claims.
- Submits payments to vendors weekly and properly controls claims expenses.
- Investigation and proccesing of claims
- Recommends Approval/Rejection of claims
- Develop company-client favorable business relationship
- Processed and audited manual paper claims for Workers Compensation clients
- Process medical claims for the sate of TN, FL, LA, KS
- Use citrx and Facets
- Production 122-160 day
- Reached out to pharmacies to verify missing required information to process claims
claims processor / collection specialist
- Processed professional (1500) and facility (UB04) claim reimbursement according to managed care contracts
- Contacted payers to follow-up on claim and payment status
- Maintains compliance with applicable Department of Insurance regulations.
- Keeps direct supervisor informed of significant developments in all assigned claims.
- Reviewed and processed medical claims and collected information as needed to insure swift and accurate payments to providers
- Responds to any inquiries from Brokers/Agents, insureds, claimants, attorneys, outside business partners and internal staff in a timely, thorough and accurate manner.
- Assign claims, pay vendors, process payments and denials.
- Responds to insureds requests, questions, and review estimates