Claims Intake Specialist

Overview

Job Title:

Claims Intake Specialist
Department:
Provider Relations

Reports to:

Claims Administration Supervisor

The Claims Intake Specialist will function in a fast-paced, high-volume environment, providing administrative support to the Claims Department through intake of claims, filing, copying, data entry, responding to requests, and directing work to its proper destination within the organization. The role includes other clerical and administrative duties to ensure smooth workflow and productivity.

• Perform data entry of new First Reports of Injury information received by phone or other method.
• Provide limited claim instructions or information to customers; direct complex inquiries to appropriate Claims Adjusters for response.
• Contact insured or other involved persons to obtain missing claim information.
• Sort, scan, classify, code and perform data entry of incoming documents and information for integration into software systems.
• Prepare and scan documents into the imaging system. Provide quality assurance for all documents scanned.
• Support the claims adjusting staff with billing issues, problems and disputes. Coordinate response to these providers from our bill review vendor.
• Maintain records, reports, and/or files.
• Copy and organize large volume files for transmission to legal counsel or others as appropriate.
• Obtain W9 documents for new or changed provider address book contact according to established procedures.
• Monitor the medical bill holds in the bill review vendor system. Notify the appropriate staff to receive direction related to these bill holds.
• Sort incoming mail and packages. Deliver to appropriate Adjusters.
• Serve as back-up for claims administration duties within the Provider Relations Department.
• Other related duties as assigned by supervisor.

High School diploma or GED equivalent.

1-3 years directly related experience.

• Bilingual in English and Spanish. Fluency in oral and written communication.
• Excellent customer service skills with ability to communicate professionally with stakeholders.
• Strong attention to detail and focus on accuracy.
• Positive attitude and willingly collaborates in a team environment.
• Ability to organize and prioritize work.
• Intermediate computer skills and ability to learn new computer applications.
• Ability to meet deadlines and respond well to direction.

• Demonstrated proficiency in MS Office (Word, Excel, Outlook, PowerPoint).
• General knowledge of payer specific or medical billing, as well as knowledge of ICD-9, ICD-10 and CPT coding helpful.

Adheres to New Mexico Mutual’s values and mission by demonstrating Service Excellence, Trust, Ownership, One Team and Boldness in thought and action.

• General office conditions with light physical demands.
• Employees adhere to safety rules and regulations including building security.
• Safe and efficient operating conditions that safeguard employees and facilities.
• Drug-free environment, drug testing prior to employment as well as upon a work-related incident.
• Exposure to VDT screens.

• Seniority level:
  Entry level
• Employment type:
  
  Full-time
• Job function:
  Other
• Industries:
  Insurance

Location:

Albuquerque, NM