Client Advocacy Claims Payer

Client Advocacy Claims Payer

The James Allen Companies Inc.

Job Description

Job Title: Client Advocacy Claims Payer

Exemption Status: Exempt, Full-time

Primary Function: Provide WOW! service and adjudicate student health insurance claims

Essential Duties and Responsibilities:

  • Provide WOW! service to internal stakeholders and external clients via webchat, email, and phone
  • Adjudicate claims to determine payment or denial
  • Assists with complex claim issues including, but not limited to, determination of pre-existing conditions, medical record checks, accident and sickness questionnaires, referrals, etc.
  • Process and pay claims in compliance with state laws, insurance policies, and company procedures
  • Read and interpret insurance policies and medical/drug procedure coding
  • Compose routine correspondence to providers, including student health centers
  • Communicate with students when follow-up claim questions arise
  • Aids the Coordinator with submitting large claims for carrier approval
  • Collaborate across departments to identify and solve problems
  • Participate in HIPAA training and compliance
  • Act as a backup for webchat, email, and phone during peak season
  • Perform other duties as required or assigned

Qualifications:

  • High School degree required; Bachelor’s degree strongly preferred
  • 1+ years medical claims adjudication experience required
  • Knowledge of medical coding required
  • Strong communication skills; interpersonal and client service skills
  • Advanced technical skills with Microsoft Office Suite and claims payment systems
  • Strong organizational skills, attention to detail, and problem-solving skills
  • Work collaboratively in a team setting
  • Ability to multitask, work under pressure and meet deadlines

  • Max. file size: 300 MB.
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