Claims Processing Specialist

One80 Intermediaries; Newtown Square (Delaware County); On-site; USD 36,000 - 48,000; Full time

Job summary

One80 Intermediaries is seeking a Claims Assistant to support the claims auditor by ensuring filings, documentation, and reports are accurately entered into our databases. The role emphasizes timely data entry, problem resolution for claimants, providers, and clients, and strict adherence to policies and state laws.

The successful candidate will manage high volumes of transactions, monitor emails, and help maintain accurate records.

Qualifications

• BA/BS preferred or HS diploma with six to twelve months related experience or equivalent
• Ability to process a high volume of transactions accurately
• Proficiency in Microsoft Office suite: Word, Excel, Outlook
• Ability to work independently and with others in a team environment

Responsibilities

• Assists claimants, providers, and clients with problems or questions regarding their claims and/or policies
• Ensures compliance with state laws, company policies, and procedures in all claim-related activities
• Monitors incoming emails and enters information into the database within 24 hours
• Enters 50% notices/Trigger Diagnosis Reports and alerts the nurse on potentially large claimants based on guidelines
• Enters LCM (Large Case Management) notices and notifies the nurse
• Processes claims, checks and SLAM Reports

Skills

High-volume transactions

Teamwork

Independent work

Education

BA/BS preferred or HS with related experience

Tools

Microsoft Office

Word

Excel

Outlook

Job description

One80 Intermediaries is seeking a Claims Assistant to support the claims auditor by ensuring filings, documentation, and reports are accurately entered into our databases. The role emphasizes timely data entry, problem resolution for claimants, providers, and clients, and strict adherence to policies and state laws.

The successful candidate will manage high volumes of transactions, monitor emails, and help maintain accurate records.