West Corporation Claims Associate in Plymouth Meeting, Pennsylvania

Claims Associate

Description

Basic Function

Responsible for:

  • Handling assigned cases in a timely manner to identify opportunities to resolve the issue by working with plan documents, carriers, providers, and members

  • Research billing issues to determine the possible cause of the error and assist with claims resubmission when needed to correct the issue

  • Assist members with setting up payment arrangements which may include reaching out to healthcare providers to determine payment options and discussing options with supervisor

  • Exercise exceptional customer service skills in an effort to optimize each contact with the member

Major Accountabilities

Claims Associate Functions-

  • Provide first-line assistance for member’s questions relating to post-service coverage of medical treatment or services which includes researching and resolving benefit claims issues, billing discrepancies, coding errors, insurance claims processing issues, and educating members on the components of their benefit plan coverage which ensuring adherence to corporate and department policies and procedures

  • Handle assigned cases in a timely manner to identify opportunities to resolve the issue by working with plan documents, carriers, providers, and members

  • Research plan information and identify where there may be conflicting information which may include escalating to supervisor or other levels of management for clarification and assistance

  • Research billing issues to determine the possible cause of the error and assist with claims resubmission when needed to correct the issue

  • Assist members with setting up payment arrangements which may include reaching out to healthcare providers to determine payment options and discussing options with supervisor

  • Utilize a variety of resources to research and resolve billing issues (e.g., plan documents, summary plan documents, benefits summaries, open enrollment material interpretation of benefits, understanding of medical, dental vision and behavioral health coverage, etc.)

  • Remain current on knowledge of Flexible Spending Accounts (FSA), Health Reimbursement Accounts (HRA), Health Spending Accounts (HSA), and benefits Summary Plan Descriptions (SPD) to resolve billing issues

  • Exercise exceptional customer service skills in an effort to optimize each contact with the member

  • Ensure that claims are processed in strict adherence to established policies, procedures, quality standards as well as applicable federal laws and regulations

  • Know and support approved departmental and corporate policies and procedures relating to claims issues

Qualifications

Applicant for this job will be expected to meet the following minimum qualifications:

Education

  • High School Degree or GED required

  • Time spent in pursuit of a Bachelor’s degree (e.g. Junior and Senior year) may be substituted in lieu of experience requirements

  • Associate degree from an accredited college or university with major course work in business administration, liberal arts, public health, healthcare management, or a related field is preferred

Experience

  • Minimum of three years customer service, healthcare, or claims experience required

Other

  • Basic Knowledge of MS Word and Excel required

  • Must score acceptably on job related testing

  • Ability to pass standardized interview

  • Based on program may need to be bilingual in English, Spanish, etc.

Knowledge of the following is preferred:

  • COBRA

  • Medicare A, B, MediGap, Supplement plans, Medicare Advantage, Medicare Part D plans

  • High deductible health plans including Health Reimbursement Accounts (HRAs) and Health Saving Accounts (HSAs)

  • Flex Spending Accounts (FSA) , including limited FSAs

  • Coordination of benefits and which plan is primary - simple and complex cases (commercial plans, Medicare plans)

  • Summary Plan Documents (SPDs) and Certificates of Coverage (COCs)

  • Government programs, resources and legislation and mandates including but not limited to Affordable Care Act, FMLA, Medicaid, CHIP

  • Group Health Plans (fully insured and self-insured)

  • Pharmacy benefits including injectable medications

  • Individual Health Plans and Exchanges plans

West is connecting people and ideas.

We are delivering on their potential.

We are improving the way we work and live.

At West, we are dedicated to delivering and improving upon new channels, new capabilities and new choices for how businesses and consumers collaborate, connect and transact. We develop technology-enabled communications that change the way we work and improve the way we live. We are a collective effort of enterprise and individuals, of communities and customers, of partnerships and families. We are the sum of our entire network - the result of brilliant ideas, dedication and the hard work of people who share our vision. We are at the core of a technology and communications engine that is changing the world.

We connect. We deliver. We are West.

Applications accepted through 10/06/17.

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Job Operations

Primary Location United States-Pennsylvania-Plymouth Meeting

Schedule Full-time

Organization Health Advocate USA

Req ID: 119306