Claims Processor CSR

Delta Health Systems, one of the leading Third Party Administrators (TPA) for self insured programs in the country with a reputation for flexibility, innovative services and outstanding customer service is looking for an innovative, self motivated, dedicated individual to fill the position of:

Claims Processor / Customer Service Rep.

POSITION RESPONSIBILITIES

• Evaluate claims and determine payment or denial according to Plan provisions, Medical Policy and Department guidelines
• Key all final information for claims release into computer
• Respond to telephone customer inquiries verifying eligibility, explaining coverage, quoting benefits and advising on the status of claims
• Maintain information files, worksheet records, benefit quote documentation
• Establish and maintain COB files, applies COB payments for final claim payment
• Research and determine proper CPT procedure and ICD-9 Diagnosis Codes
• Research and respond to written correspondence from participants, providers, and local unions/employers
• Prepare transmittal and send claims to Benefit Review for processing instructions
• Work effectively to achieve acceptable production and accuracy standards
• Display maturity, composure and ability to operate under stress conditions
• Perform other duties as assigned
• Specialty duties include:  Enter dates of service on dental pre-determinations.  Process voided checks and refund checks.  Maintain weekly disability files and process claims.

KNOWLEDGE AND SKILL

Eighteen (18) months experience as a Claims Processor or similar function.  Must have a broad knowledge of medical terminology and must possess excellent written and oral communication skills.  Must possess good judgment skills and ability to interpret Department guidelines and contractual benefits and possess a high school diploma or equivalent. Satisfactory completion of medical terminology course may substitute for six (6) months of equivalent experience.

Delta Health Systems is committed to long-term growth, employee development and superior client service.  Join a great team with terrific total comp package.

Equal Opportunity Employer

Delta Health Systems is committed to long-term growth, employee development and superior client service.  Join a great team with terrific total comp package.

Equal Opportunity Employer