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HFHP Claims Examiner I - HF Claims Administration, HF Administra
MELBOURNE FL 32941
Category: Other
  • Your pay will be discussed at your interview

Job code: lhw-e0-90593306

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Summary

  Job posted:   Wed Jun 6, 2018
  Distance to work:   ? miles
       
  1 Views, 0 Applications  
 
HFHP Claims Examiner I - HF Claims Administration, HF Administra
To be fully engaged in providing Quality/No Harm, Customer Experience, and Stewardship by being responsible and accountable for the accurate and timely claims processing of all claim types. Claims must be processed with a high level of detailed quality and in accordance with claims payment policy and by the terms of our customer/provider contractual agreements.

* Actively participate and collaborate with entire department to continuously improve workflows and performance.
* Communicate identified issues with claims and claims processes to the Lead within the claims department.
* Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions and employing active listening techniques.
* Adapt to and positively influence change by accepting feedback and capitalizing upon opportunities to continuously improve.
* Adjudicating claims, while ensuring claims are handled appropriately; claim contains pertinent and correct information for processing; member is eligible for coverage on the date(s) of service; services have the required referral/authorizations; accurate final claims adjudication/adjustments by using on-line computer claims payment system, which includes research on previously processed claims when needed; identify billing patterns, processing errors and/or system issues that inhibit the final adjudication of claims.
* Meet the performance goals established for the position in the areas of: efficiency, accuracy, productivity, quality and attendance.
* Utilize Claims Department policies & procedures, Support Point, workflows and manuals to meet departmental production and quality metrics.
* Follow processes and work independently to ensure ability to meet or exceed Key Performance Indicators (attainment and/or productivity targets) aligned with specific function/application.
* Research claims for completion and appropriateness.
* Review and handle rejected claims as necessary
* Ensure timely, accurate claim processing services to client
* Track and report on any overpayment recovery utilizing refund process
* Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMC/Medicare guidelines, benefit plan documents/certificates)
* Insure manually pricing is accurate and appropriate


* High school diploma with 6 to 12 months of vocation/post high school education or equivalent work experience*__*
* Minimum of 1 year or more of claims processing, claims customer service or related health care billing experience.*__*
* Knowledge of medical benefits, medical and dental terminology*__*
* Knowledge of claim adjudication and benefit plan application for indemnity plans, HMO plans, POS plans or Medicare*__*
* Proficient in Microsoft Office including: Microsoft Word; Excel and Access*__*
* Excellent customer service skills with ability to explain complicated benefit issues to members and diffuse hostile encounters*__*
* Excellent oral and written communication skills*__*


**Job:** **Operations*

**Organization:** **HF Administrative Plan Inc*


**Title:** *HFHP Claims Examiner I - HF Claims Administration, HF Administrative Plan Inc., Full-Time*

**Location:** *Florida - Brevard County-Melbourne*

**Requisition ID:** *036817*

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