Remote Medical Claims COB Processor I

Page Mechanical Group, Inc.; Northern (KY); Hybrid; USD 25,000 - 29,000; Full time

Benefits offered by this job

Medical, Dental, Vision, Pharmacy, L&D

401K- Matching

FSA

Employee Assistance Program

PTO and Holidays

Job summary

Moda Health seeks a COB Claims Processor to investigate and process Coordination of Benefits claims, assisting with customer inquiries regarding policies and administration. This full-time work-from-home role emphasizes accurate, timely processing and strong communication with claimants, providers, and other carriers.

The ideal candidate will have at least 6 months of claims or customer service experience, excellent typing and data-entry skills, and familiarity with Facets, Word, and Excel.

Qualifications

• High School diploma or equivalent.
• Minimum of 6 months medical claim processing or customer service dealing with all types of plans/claims and consistently exceeding performance levels.
• Professional and effective written and verbal communication skills.
• 10-key proficiency of 135 spm net on a computer numeric keypad.
• Type a minimum of 35 wpm net on a computer keyboard.
• Ability to maintain balanced performance, which consistently exceeds minimum expectations in areas of production and quality.
• Good analytical, problem solving, decision making and detail-oriented skills with ability to shift priorities as needed.
• Good organizational abilities and the ability to handle a variety of functions.
• Ability to multitask and work well under pressure and meet timelines.
• Ability to maintain confidentiality internally and externally and project a professional business image always.
• Proficiency in claims processing systems; Facets, Word, and Excel.
• Knowledge and understanding of Moda Health administrative policies affecting claims and customer service.
• Demonstrates work habits that include Moda Health standards of attendance and punctuality, as well as flexibility.

Responsibilities

• Communicates via telephone with claimants, policyholders, providers, and other insurance carriers.
• Review, analyze, and resolve claims through the utilization of available resources for complex claims.
• Analyze and apply plan concepts to claims that include deductible, coinsurance, copay, COB, and out of pocket, etc.
• Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
• Release claims by deadline to meet Company, state regulations, contractual agreements, and group performance guarantee standards.
• Maintain discretion and confidentiality in compliance with federal, state, and departmental guidelines.
• Reviews Policy and Procedures (P&P) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.
• Monitors and maintains unit inventory.
• Thoroughly documents actions as required by internal procedure and market conduct guidelines.
• Assists internal departments with correcting eligibility and programming issues as needed.
• Responds and follows up using FACETS, Content Manager and E-mail.

Skills

Written & verbal communication

Analytical & problem solving

Multitasking & prioritization

Organization & attention to detail

Confidentiality & professionalism

Education

High School diploma or equivalent

Tools

Facets

MS Word

MS Excel

Content Manager

Email handling

Job description

Moda Health seeks a COB Claims Processor to investigate and process Coordination of Benefits claims, assisting with customer inquiries regarding policies and administration. This full-time work-from-home role emphasizes accurate, timely processing and strong communication with claimants, providers, and other carriers.

The ideal candidate will have at least 6 months of claims or customer service experience, excellent typing and data-entry skills, and familiarity with Facets, Word, and Excel.