Job Abstract

The claims clerk is responsible for ensuring timely and accurate documentation categorized and indexed into OnBase. The claims clerk will be responsible for proper chain of custody handling and proper file retention standards.  Review Claim Documents for completeness and validity to adjudicate claim within organizational guidelines. Request additional information needed to process claims from providers and members. Retrieve images from Onbase and Outlook. Manage claims from inception to resolution within designated limit. Meet or occasionally exceed established standards for productivity and quality. Maintain claim turnaround time set. Communicate trends and other opportunities for improvement to management. Maintain accuracy and quality with a less than 2% rate. Ensure all appropriate documentation , including any missing documentation is concise. Reports to work on time and maintains a satisfactory attendance record.
Attend and actively participate in departmental meetings, trainings and coaching sessions. Maintain patient privacy and confidentiality in accordance with HIPAA standards. Seek and takes advantage of development opportunities that will improve technical/functional expertise. Resolves routine problems within established guidelines and seeks assistance as needed, or required.

·       Sort and import claim documents received via electronic fax or e-mail for ingestion into OnBase.

·       Research to identify unmatched mail items and forward to the appropriate department or examiner.

·       Index new claims via RightFax, Outlook, or OnBase.

·       Input initial benefit lines into Mainframe system for new claims.

·       Support examiners and analysts by creating and sending out letters for requested information.

·       Research and Identify policy information and create verifications with found information for outside companies.

·       Answer telephones and provide basic customer service to outside companies.

·       Accumulate reports with policy status for outside companies. 

·       Accumulate reports with policies found regarding state searches.

·       Complete the Check Pull report daily.

·       Process voids and stop-payments for claim checks.

·       Concurrently access multiple databases, software programs, and/or online tools to perform required job functions. 

·       Attend and actively participate in departmental meetings, trainings, and coaching sessions. 

·       Maintain high degree of quality control and validation of completed work.

·       Meet or exceed established standards for productivity and quality.

·       Maintain customer privacy and confidentiality in accordance with HIPAA standards.

• Ability to compile and review information to make sound decisions
• Skilled in performing intermediate arithmetic calculations
• Excellent typing and writing skills,
• Proficiency in Microsoft Office Suite (i.e. Outlook, Excel, Word) and other basic computer programs
• Ability to thrive in fast paced environment while working independently and with limited supervision
• Positive team oriented attitude with flexibility to adjust to changes as they arise
• Ability to multi-task
• High attention to detail and accuracy
• Working knowledge of Onbase, and Mainframe

• High School Diploma
• 1-2 years related experience and/or training, or equivalent combination of education and experience;
• Knowledge of insurance industry and claims handling experience preferred