Field Claims Representative handling property insurance claims under general supervision at Auto - Owners Insurance. Investigating, evaluating, and ensuring timely resolution of claims for agents and insureds.
About the role
- Claims Associate managing medical claims processing and ensuring timely provider payments in Asheville office. Responsible for handling paper claims and ensuring accurate adjudication.
Responsibilities
- Responsible for all accounting functions related to a designated area of physical and behavioral health medical claims processing to ensure that providers receive timely and accurate payment.
- This position is responsible for managing paper claims.
- Keying of valid paper claims to claims adjudication system.
- Manage invalid claims - return mail to provider.
- Processing of rejections out of Perfect Claims.
- Return mail or email rejection letters to provider.
- Sending reconsideration letters regarding claim appeals received by Vaya.
- Support claims adjudication by finalizing claims processed electronically for payment and reviewing claim adjudication results for both Title XIX and non-title XIX claims, payment, and denial patterns.
- Ensure adjudication accuracy of keyed claims in the claims processing system by adhering to policy and procedures.
- Tracking all paper claims and evaluating claims to determine Clean claim vs. Non-clean claim.
- Finalizing keyed claims processed for payment and maintain claims adjudication workflow, reconciliation, and quality control measures to meet or exceed prompt payment guidelines.
Requirements
- High school diploma or GED required.
- Associate degree in Business Administration, Accounting, Finance or related field preferred.
- Knowledge of computerized claims systems; organization structure of MCO claims processing, methods and procedures utilized in claims processing, medical terminology (ICD-10/CPT/HCPCS and Revenue codes), third-party reimbursement, and Coordination of benefits (COB).
- Ability to adapt to a rapidly evolving work environment, work independently, and communicate with a variety of personnel and providers.
- Ability to process moderate to more complex claim issues.
- Knowledge of all types of health insurers and coordination of benefits preferred.
- Knowledge of Microsoft Office applications, including Excel, Word, and Outlook.
- Excellent oral and written communication and interpersonal skills required.
- Meticulous and analytical skills.
- Self-accountable; scheduled shift, Teams Chats, completion of assigned tasks, etc.
- Must be able to work effectively in a team environment with a wide variety of culturally diverse providers.
- Must have strong problem-solving, project management, and negotiation skills.
- Must have the ability to multi-task; must have effective organizational skills.
- Ability to establish and maintain good working relationships with agency personnel, contract agencies.
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