Claims Clerk

Description

POSITION TYPE: Hourly, Non-Exempt

BARGAINING UNIT: Bargaining Unit

WORK ENVIRONMENT: Hybrid

SEIU Healthcare IL Benefit Funds is a dynamic healthcare organization committed to providing the highest quality health and retirement benefits in the most financially responsible manner, while always acting in the best interest of the union members. We serve over 20,000 union workers in the Nursing Home, Home Care, Child Care and Personal Assistance industries with health and pension benefits. Our employees epitomize the Fund’s core values of quality service, interdependence, effectiveness, and accountability through the alliance to each other, the organization and those we serve.

Position Summary

The Claims Clerk is responsible for managing and monitoring claims clerical functions within the Medical Benefits & Claims department and for providing general claims support to the claims team.

This position will work closely with the claims team members as well as other department staff throughout the organization. Communication with both external and internal stakeholders and providing excellent customer service is vital for this role.

Key Duties And Responsibilities

The Claims Clerk will be responsible for the following:

• Review and distribute incoming documents throughout the department
• Print and mail non-system correspondence such as provider reconsideration letters
• Scan paper documents and load electronic documents into the benefit administration system
• Create and upload pend letter files, member and zero-pay EOB files to the printing and mailing company
• Add new provider records in the system
• Load pre-certifications files from external vendors
• Load vendor referrals into the benefit administration system
• Rename and save vendor referrals into the Claims drive
• Scan, image, organize and maintain documents, adhering to the organization's document lifecycle procedures, and archive inactive records in accordance with the document retention policy
• Attend and participate in various meetings, including monthly All Staff meetings, department meetings, training sessions, task force or committee meetings, and other meetings as deemed appropriate to share, discuss, and solution for question or error trends, as well as identify potential process improvements
• Create one-on-one (1:1) agendas with the Director of Health Plans & Medical Claims using the Purpose, Outcome and Process (POP) Model and keeping thorough notes for each meeting
  
  

Privacy And Security Responsibilities

This position requires employee to handle Personal Identifiable Information (PII) and Protected Health Information (PHI) for our members. You will be responsible and accountable for maintaining the confidentiality, integrity, and availability of all PII and PHI. Report any suspected HIPAA violation or breach to our HIPAA Privacy and Security Officer.

Requirements

Education Requirements:

• High school diploma or equivalent required
  
  

Job Requirements

• A minimum of 1-2 years’ general office experience
• Data entry experience
• Ability to type 35 words per minute accurately
• Knowledge of standard office equipment such as scanner, printer, photocopier and fax machines
• Basic skills in Microsoft Office (Word, Excel and Outlook)
• Excellent written and verbal communication skills
• Ability to communicate effectively with internal and external stakeholders
• Ability to organize and prioritize task
• Ability to demonstrate teamwork and work independently
• Ability to meet deadlines
• Exercise clear and concise judgment
• Ability and willingness to assist in special projects and handle multiple tasks
  
  

Preferred Skills

• Experience in a claims operation
• Knowledge of the Fund’s benefit administration system (HPS or basys)
• Experience with project management software, such as Smartsheet
• Experience working in a remote environment with laptop provided
• Experience with virtual conference software (Teams and Zoom)
• Internal and external awareness of social movements, labor movements, and political issues that impact the work and the organization
  
  

Physical Demands

• Ability to lift a minimum of 30lbs
• Flexible work schedule when workflow requires
  
  

Career Development & Continuing Education Opportunities: Yes

Benefits

SEIU Healthcare IL Benefit Funds offers a comprehensive health benefits (medical, dental and vision coverage) for employees and eligible dependents, including no employee premium option for employee only; competitive compensation; generous holidays and PTO policies; and a pension retirement plan.

Diversity creates a healthier atmosphere: SEIU Healthcare IL Benefit Funds is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

The SEIU Healthcare IL Benefit Funds vision is to create a more just and equitable society that fosters a lifetime of quality healthcare and financial security for all. We hope that our social justice values and the responsibility we take to operate a socially conscious organization aligns with your professional desire to contribute and serve with purpose.