Claims Lead

Job Description As a Senior Claims Medical Processor, a qualified candidate will work within our growing Health Benefit Fund team supporting our wide array of union members. Member services standard hours are between 8 - 5 pm. This is a n in-house, onsite position.Responsibilities:Accurately process claims by researching benefits, claim policies, procedure and reviewing claim edits.Answer incoming telephone calls to assist customers with explanations and issue resolution of healthcare policies, benefits, eligibility and coverage.Understand and update claim system configuration.Process claim adjustments, voids, and refunds.Maintain claim resources, reference materials and training tools.Manage daily workloads to ensure production goals are met and calls are resolved timely.Verify accurate data entry, to include correct patient, coding, dollar amounts and provider information.Maintain accuracy levels of 98% or higher for both payment and statistical data.Work in assigned work groups/queues and assist in other areas as needed.Work closely with senior staff, maintaining daily communication/updates.Ability to train and coach others.Ability to handle more complex cases and serve as a subject matter expert.Perform other duties as assigned.Required Qualifications:High School Diploma or equivalent.Knowledge of medical/insurance terminology.Extensive knowledge of ICD-10, CPT, and CDT.Excellent customer service – member first mentalityResearch skills and ability to evaluate claims in order to resolve accurately.Ability to interpret health plan contracts and benefit language.Excellent oral and written communication skills that are shown in a respectful, pleasant and professional manner.Work habits that include punctuality, ability to be a team player, willing to assist and support peers, as well as work independently with minimal direction.Excellent negotiation, analytical, and problem solving skills.Ability to prioritize workloads and perform under time pressures.Preferred Qualifications :Five years’ experience as claims processorAbility to determine and process Coordination of Benefits, claims adjustments, and stop loss coverages.Experience performing claim audits.Experience taking inbound calls.