Responsibilities
- Process all health-related claims (Disability, Hearing, Hospital, Medical, Vision, etc.) for Funds' and union staff in a timely, accurate and confidential manner
- Respond to incoming calls or walk-in from both union and fund wide staff related to eligibility, benefits, program services, and claims inquiries in a professional and hospitable manner
- Make outgoing calls to providers, members and Collection Agencies to resolve claim inquiries
- Complete and submit daily production sheets, reports, checklists, etc. to capture and track incoming or outgoing workflow (e.g., call tracking issues)
- Protect and maintain all claims related documents and data to ensure compliance with Protected Health Information (PHI) and complies with Health Insurance Portability and Accountability Act (HIPAA) guidelines
- Interact with Fund departments to assure return of requested data and other materials
- Train new and current employees on new systems, benefits and program services to assure that all claims and service staff are well informed on all the most current details related to the Funds' benefit plans, policies, eligibility and claims processes, programs and system related procedures
- Perform additional duties and projects as assigned by management
Qualifications: Bachelor's Degree or equivalent years of work experience required Minimum two (2) years health claims processing experience required; experience in Quality Control preferred Provide a positive service attitude required for dealing with internal and external customers; high volume call center and in person customer service experience preferred Must be able to handle sensitive, confidential information with tact and discretion Excellent organizational, interpersonal and communications skills, both written and verbal; bilingual a plus Knowledge of National Benefit Funds eligibility rules including plan benefits and limitations for Aetna, GHI, HIP required; Good knowledge of International Classification of Diseases (ICD-10), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPS) Basic skill-level in Microsoft Excel and Word; ability to navigate web-based applications Excellent attention to details and ability to troubleshoot as appropriate Ability to work well under pressure to meet deadlines, multi-task, make sound judgments, and prioritize work assignments Must be able to work independently and be a team player