Assistant Claim Specialist
Company: Allied Benefit Systems
Posted on: January 17, 2022
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
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).
Process Medical and Dental claims as well as invoices, in the
Read, analyze, understand, and ensure compliance with clients'
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
Analyze claims for billing inconsistencies and medical
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
Assist and support other Claim Specialists as needed and when
Attend continuing education classes as required, including but not
limited to HIPAA training.
Communication - Communicates effectively both internally and
externally, where applicable. Includes both written and verbal
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
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
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
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
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
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
High School Graduate
WORK ENVIRONMENT - Virtual
Keywords: Allied Benefit Systems, Chicago , Assistant Claim Specialist, Other , Chicago, Illinois
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