Posted in Other 30+ days ago.
We enjoy the important work we do every day on behalf of our members.
Job Summary
The Complex Claims Processor II is responsible for the timely and accurate processing of claim inventory as assigned by the Complex Claims Supervisor. Using analytical and problem solving skills, the Complex Claims Processor II is expected to fully research and resolve all complex issues and problem codes for each claim. Additionally, the Complex Claims Processor II may be assigned to work on claims processing and reporting for specific projects and for member reimbursements.Job Description
Process complex claims as assigned by supervisor:
Additional specialized tasks:
Quality & Production:
Other:
Requirements
EDUCATION: Associates degree or equivalent business experience in a claims/customer service healthcare environment preferred.
EXPERIENCE: 24-48 months experience as a Tufts Health Plan Complex Claims Processor or similar claims processing or customer service experience required
SKILL REQUIREMENTS: Experience with Tufts Health Plan's internal applications, such as HRP,Monument Xpress, Macess, CCMS preferred. Understanding of managed care concepts and a strong understanding of CPT, ICD-9 (ICD-10), HCPCS coding guidelines and CMS1500 & UB04 billing forms preferred. Position requires strong problem solving and analytical skills with the ability to multi-task. Must be able to work independently and as a part of a team. Advanced verbal and written skills to communicate internally and externally. Working knowledge of Microsoft Office applications and internet navigation is preferred.
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: Overtime may be required during peak volume periods as requested by management. Requires ability to use personal computer, sitting for extended periods of time.
What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!
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