Part-Time Claims Associate

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The Claims Associate will be responsible for processing claims, including out-of-network claims and providing telephone support to the members and providers who have claims questions. To be qualified for this position, you must have strong attention to detail and excellent customer service skills.

• Process and enter approved out-of-network claims into SPECS.
• Provide customer support via phone or email to clients, members and providers who have questions related to claims, eligibility and reimbursements.
• Enter denied claims into SPECS.
• Mail claim denial letters to provider and members.
• Open mail and date stamp claims.
• Scan paper claims, verify data and work claim rejections.
• Work claim rejections from the 837 (e-Claims) files in SPECS.
• Enter CMS/HCFA 1500 paper claims into SPECS.
• Approve pending claims in SPECS.
• Address problem claims and assist in resolving claims issues.
• Mail provider and member checks and Explanation of Benefits reports.
• Abide by all CMS and CEC claims-related policies and procedures.
• Perform other duties or special projects as assigned.

• 1+ years health-related claims processing experience.
• Knowledgeable of ICD-10 as well as eye care procedure codes and terminology.
• Proficient in essential Microsoft programs (Word, Excel and Outlook).

To apply:
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