Claims Coordinator

Sun Technologies; Mason, Northern (OH, KY); Hybrid; USD 28,000 - 33,000; Part time

Benefits offered by this job

Medical Insurance

401(k)

Sick leave

Job summary

Sun Technologies in Mason, Ohio is seeking a Claims Coordinator for a 2-3 month contract to efficiently process vision insurance claims and related tasks. The role requires attention to HIPAA compliance and timely handling of claims.

Pay is $22/hour with potential extension based on performance. Benefits include ACA-compliant medical insurance, a 401(k), and sick leave as required by law.

Qualifications

• Requires ability to enter data accurately and quickly.
• Able to multi-task and prioritize issues with attention to detail.

Responsibilities

• Efficiently processes a variety of vision insurance claims or adjustments.
• Determines any special plan requirements prior to billing.
• Reviews claims for completeness and compliance with business requirements.
• Prepares data for auto adjudication by reviewing images and transcribed data.
• Coordinates claim error corrections as needed.
• Maintains Medicare/Medicaid Pend Claims process.
• Participates in special projects and rework efforts.
• Implements processing changes due to new plans or benefit designs.

Skills

Data entry

Multitasking

Attention to detail

Prioritization

Education

High School diploma or equivalent

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

Job description

Location

• : Mason
• , Ohio

Duration

: Expected 2-3 month contract with possible extension

Job Description

Pay Rate: $22/hr the pay rate may differ depending on your skills, education, experience, and other qualifications.

Featured Benefits:

• Medical Insurance in compliance with the ACA
• 401(k)
• Sick leave in compliance with applicable state, federal, and local laws

GENERAL FUNCTION

The Claims Coordinator accurately and efficiently processes all types of claims from source documents, maintaining compliance with the insurance plan requirements and with high regard for adhering to goals for quality and claims production rates. Also performs other complex claim processing which include but not limited to Medicare/Medicaid Pend process, Corrected Claims, and running daily reports.

MAJOR DUTIES AND RESPONSIBILITIES

• Efficiently and accurately processes a variety of vision insurance claims or adjustments.
• Determines any special plan requirements prior to billing.
• Reviews claims before entry for completeness and compliance with business requirements.
• Effectively and accurately reviews images and transcribed data in the portal in preparation for auto adjudication.
• Coordinate and complete claim error corrections
• Maintains the Medicare/Medicaid Pend Claims process
• Participates on special project initiatives, including rework efforts as needed.
• Understands and quickly operationalizes processing changes resulting from new plans, benefit designs.
• Maintains compliance with HIPAA guidelines and regulations.
• Works with supervisor and co-workers to provide strong customer service and communication with key customer interfaces that include Account Managers, Operations, Information Systems, Client Representatives and leadership team.
• Assists Team Lead in a backup lead capacity
• Assists with root cause analysis of claim issues to resolve thoroughly and completely for clients
• Contacts stores or providers (when necessary) to obtain additional information or follow up on claims.

BASIC QUALIFICATIONS

• High School diploma or equivalent work experience
• 3+ year(s) of data entry experience
• Able to multi-task and prioritize issues
• Strong attention to details

PREFERRED QUALIFICATIONS

• Knowledge of Medicare/Medicaid business
• Knowledge of vision benefits and/or insurance industry
• Proficient in Microsoft Word, Excel and Access