Posting Date

Responsibilities and duties

  • Approve or reject health claims according to the SPD and plan guidelines.
  • Complete data entry into Group+ to adjudicate claims charges.
  • Perform appropriate correspondence via letter or telephone for claim completion.
  • Answer inquiries regarding eligibility and confirmation of benefits for coverage of proposed services for TPA plans.
  • Answer inquiries regarding status of claims payment for TPA plans.
  • Document all customer service contacts.
  • Perform other duties and assignments as requested by manager.

Qualifications

Education:

High school graduate.

Experience:

  • Medical and/or insurance background desirable.
  • Medical coding knowledge helpful.

Skills and Abilities:

  • Excellent verbal and written interpersonal and communication skills including high level of listening skills.
  • Customer oriented with the ability to adapt and respond to different types of customers with sensitivity.
  • Demonstrate positive leadership skills and take initiative.
  • Ability to make quick and appropriate decisions despite interruptions.
  • Flexibility with changing work patterns and/or varying workloads.
  • Excel at problem solving.
  • Attention to detail with the ability to multi-task and prioritize while managing time effectively.
  • Proficient in use of Microsoft Office software.
  • Ability to develop and maintain a strong sense of teamwork.
  • Must be able to maintain call center hours.

Supervisory responsibilities

No supervisory responsibilities

Schedule

This is a full-time position

Location

Everence Corporate office – Goshen, Indiana

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