Job Application - World Insurance Associates

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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.