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Claims Operations Generalist

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Job Description

Job Description

Summary

The Claims Operations Generalist under the direction of the Claims Project Manager is responsible for assisting Claims Operations in various functions to maintain compliance with regulatory and contractual standards. This teammate will participate in claims auditing, adjudication, adjusting, investigation/analyzing and other special projects as needed.

Duties and Responsibilities

Adjudicate claims assigned by leadership

Adhere to deadlines

Analyze claims based on contracts and troubleshoot EZ CAP System configurations to identify any potential issues and improve the payment accuracy and overall quality.

Assist in health plan audit review and response.

Interacts with Claims Management team and provides feedback to senior management for improvement.

Communicate effectively with leadership and all claims production staff, as well as with external vendors, consultants and other organizations.

Participates in trainings to maintain current process for claims adjudication.

Analyze and document trends per organizational guidelines for Senior Management.

Provide feedback to Claims teammates for remediation.

Promote a spirit of cooperation and understanding among all personnel.

Adhere to organizational policies and procedures.

Adhere to MedPOINT Management s core value: Accountability, Community, Celebration, Integrity, Innovation & Collaboration

Minimum Job Requirements

3 years of Claims Examiner experience.

Strong organizational and mathematical skills.

The ability to work independently and adhere to deadlines.

Skill and Abilities

Experience in a managed care environment preferred.

Excel and analytic experience

Must be detail oriented, able to work independently and multitask.

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
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