Claims Clerk

Job Summary

Provides clerical support for the Claims department, including receipt and processing of daily incoming mail. Performs photocopying and pulling claims and Explanations of Benefits (EOBs) off the on-line system using Filenet and Emdeon software. Annotates items in claims software systems. Maintains control of incoming faxes, including appropriate logging of receipt. Maintains files for Administrative Checks.

Required:

• High School degree or G.E.D.
• 4 years' clerical experience, with business office experience
• Good written and verbal communication skills
• Experience with Word and Excel

Preferred:

• Experience in the Healthcare Industry

• Opens and sorts incoming Claims mail.
• Pulls documents off the on-line system, including claims files, correspondence, and appeals for audit purposes to assist Claims Reviewer with regular audits.
• Produces form letters to Veterans and providers.
• Interfaces with Claims Reviewers to provide support with their administrative needs.
• Coordinates records with other Tri West departments to assist with specialized claims audits as requested.
• Pulls claims documentation off the system for the Legal department as required.
• Supports department with other functions, including maintain the Administrative Check files.
• Supports the Collections unit with logging and controlling of collections cases.
• Performs other duties as assigned, including copying, filing, and other clerical support.
• Regular and reliable attendance is required.

Communication / People

Skills:

Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, Tri West Intranet, the Internet, and department software applications.

Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

Organizational

Skills:

Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

Technical

Skills:

Knowledge of claims documentation processes; experience working with on-line records; typing and key entry experience.

Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.

Working Conditions:

• Works within an office environment, with minimal travel
• Availability to cover any work shift

Tri West job postings typically include a salary range,
which can vary based on the specific role and location
, but generally this position ranges from around $37,000 to $41,000 per year.