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Claims Administrator - Burlington, IA
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Position Summary
- This position is responsible for, but not limited to
obtaining information from the insured or designated person for the
purpose of processing a medical, dental, vision, flex, HSA and/or HRA claim
with insurance carrier, insured and/or provider. Review settled claims to determine that payments and
settlements are made in accordance with company practices and procedures. The claims administrator is responsible for building
relationships with internal and external customers. The claims
administrator will communicate with members, clients/brokers and providers
to assist in the processing of claims. The claims administrator is
responsible for understanding and analyzing Plan designs, plan documents
and ACA requirements
Essential Duties and Responsibilities
·
Display a thorough
knowledge of client benefit plans including plan language, ERISA and ACA
regulatory requirements
·
Rectify participant claims
issues as they arise
·
Display a thorough understanding
of HIPAA
·
Maintain relationships
with internal and external stakeholders
·
Provide quality customer
service to clients
·
Communicate with insured,
agents, providers and stop loss carriers to obtain details necessary for proper
claims adjudication
·
Transmit payments and
investigate issues until files are resolved
Qualifications
· High school diploma or GED required
· Previous experience in TPA industry, healthcare industry and
specifically billing or coding preferred
· Possess strong administrative and computing
skills, including Microsoft Office (Word, Excel and Power Point)
· Able to work independently and enjoy a high
degree of interaction with team members.
· Self-motivated and driven. Maintain a sense
of urgency and ability to work with and meet deadlines.
· Demonstrate effective written and verbal
communication, including the ability actively listen, and problem solve with
minimal assistance.
· The ability to multitask, prioritize, work independently,
and use discretion surrounding sensitive information.
· Ability to maintain a professional demeanor and
positive attitude
This description is not meant to be
all-inclusive. To perform this job successfully, an individual must be
able to perform each essential duty satisfactorily. The requirements listed
within the full job description (which will be provided upon interview) are
representative of the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities to perform
the essential functions.