Claims Processor

Title: Claims Processor 3 Department: Claims Union: OPEIU 29 Grade: 18

Responsible for independently processing all types of health claims on an assigned Plan(s), and for assuming primary or back‑up customer service responsibilities as necessary.

• Independently process all types of health claims in accordance with assigned Plan(s).
• Perform customer service responsibilities for providers and members as needed.
• Generate correspondence and form letters.
• Maintain current knowledge of assigned Plan(s) and effectively apply this knowledge in the payment of claims.
• Assist other processors with claims as needed to minimize backlog.
• Perform other related duties and special projects as assigned.

• High school diploma or general education degree (GED); two years related experience processing all types of group health and/or dental benefit claims.
• Knowledge of all aspects of benefits claims processing and basic claims adjudication principles and procedures, medical and/or dental terminology, and ICD-9 and CPT-4 codes.
• Ability to type 45 WPM.
• Ability to read and interpret documents such as procedure manuals and health plans.
• Write routine reports and correspondence. Ability to speak effectively and present information in one‑on‑one and small group situations to customers, clients and other employees of the organization.
• Calculate figures and amounts such as discounts, interest, proportions, and percentages.
• Ability to solve practical problems.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
• Ability to meet production and quality goals on a consistent basis.

We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

Compensation: $27.81/hr