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Assistant Claim Specialist

Company: Allied Benefit Systems
Location: Chicago
Posted on: January 17, 2022

Job Description:

Description

Job Title: Assistant Claim Specialist

Department: Claim Department

FLSA Status: Exempt

Job Status: FT

Reports To: Assistant Manager, Claim Operations

Positions Supervised: None

Work Schedule: Flexible start, full-time hours

Assessments: PI Behavioral and Cognitive assessments

Position Summary

The Assistant Claim Specialist is an entry level position for claim processing. This person will use independent judgement and discretion to review, analyze, and make determinations regarding payment, partial payment, or denial of medical and dental claims, as well as various types of invoices, based upon specific knowledge and application of each client's customized plan(s).

Essential Functions
Process Medical and Dental claims as well as invoices, in the QicLink system.
Read, analyze, understand, and ensure compliance with clients' customized plans
Learn, adhere to, and apply all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto.
Independently review, analyze and make determinations of claims for: 1) reasonableness of cost; 2) unnecessary treatment by physician and hospitals; and 3) fraud.
Review, analyze and add applicable notes in the QicLink system.
Review billed procedure and diagnosis codes on claims for billing irregularities.
Analyze claims for billing inconsistencies and medical necessity.
Authorize payment, partial payment or denial of claim based upon individual investigation and analysis.
Review Workflow Manager daily to document and release pended claims, if applicable.
Review Pend and Suspend claim reports to finalize all claim determinations timely.
Assist and support other Claim Specialists as needed and when requested.
Attend continuing education classes as required, including but not limited to HIPAA training.

Position Qualifications
Communication - Communicates effectively both internally and externally, where applicable. Includes both written and verbal communication.
Customer Focused - Works well with customers/clients both internal and external, promotes a positive image of the company and department, and strives to solve issues raised by customers.
Dependability - Meets deadlines, works independently, accountable, maintains focus, punctual, and maintains good attendance record.
Initiative - Takes action independently, seeks new opportunities, and strives to see projects to completion.
Interpersonal Skills - Builds strong relationships, is flexible/adaptable, works well with others, and solicits feedback.
Job Knowledge - Understands the facets of job, aware of duties and responsibilities, and keeps job knowledge current.
Organization Skills - Information organized and accessible maintains efficient work space, and manages time well.
Problem Solving - Strives to understand contributing factors, works to resolve complex situations.
Productivity - Manages workload, works efficiently, and meets goals and objectives.
Self-Development - Looks for opportunities to increase knowledge, works to increase responsibility, strives to achieve personal goals and/or maintains licenses and other pertinent requirements.
Sense of Urgency - Meets deadlines, establishes appropriate priority, and completes tasks assigned in timely manner.
Teamwork - Accountable to team, works to meet established deliverables, appreciates view of team members, and respectful.
Technical Skills - Maintains current understanding of technical process/equipment, uses technology to increase performance/productivity; effectively uses online tools and resources.

Requirements

SKILLS & ABILITIES

All applicants must have strong analytical skills and knowledge of computer systems. Continuing education in all areas affecting group health and welfare plans is required. Applicants must demonstrate the desire to assist the Team with exceeding all established goals.

Experience

Applicants must have medical claims processing experience. Prior experience with dental and vision processing is preferred, but not required. Applicants must also have knowledge of CPT and ICD-10 coding.

EDUCATION

High School Graduate

WORK ENVIRONMENT - Virtual

Keywords: Allied Benefit Systems, Chicago , Assistant Claim Specialist, Other , Chicago, Illinois

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