Claims Examiner Team reputed company

reputed company reputed company reputed company IL Benefit Funds is a dynamic reputed company organization committed to providing the highest reputed company health and retirement benefits in the most financially responsible manner, while always acting in the best interest of the reputed company members. We serve over 20,000 reputed company 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 reputed company service, reputed company, effectiveness, and accountability through reputed company to reputed company other, the organization and those we serve. Position reputed company: The Claims Examiner, Team reputed company will be a designated reputed company of contact for reputed company department team members, and work in a supportive leadership role to the Claims Supervisor and Claims Director. The Claims Examiner, Team reputed company will effectively research and resolve daily operational issues to ensure the claims department can appropriately pay claims, respond to member and provider inquiries. The Claims Examiner, Team reputed company will need a high proficiency of both collaboration and independent work to ensure members and providers are serviced reputed company and with high-reputed company standards. The Claims Team reputed company will also be responsible resolving issues reputed company to claims processing, configuration, and appeals. This position must be reputed company to carry out the Claims Examiner, Level 3 reputed company of responsibilities. This position will serve alongside other department Team Leads on assigned organizational initiatives, such as Strategic Plan tracking and updating reputed company. Communication with both reputed company stakeholders, and the ability to reputed company and reputed company others to carry out departmental processes to reputed company accurate examination of claims is vital for this role. This position will use their expertise, analytical skills, and critical thinking to support reputed company in completing assignments, overseeing reputed company towards goals, coaching examiners as needed, performing duties in a reputed company manner and representing the organization in a reputed company manner, and understanding that attitude and behavior reputed company. The Claims Examiner, Team reputed company will be responsible for the following: Key Duties and Responsibilities:

• Manage the claims department reputed company ticket inventory and follow up with staff to get aged tickets reputed company out.
• Work with staff to ensure the deadlines for claims initiatives for the organizational Strategic Plan are met.
• Research, resolve, and or reputed company recommendations to first level issues from the staff reputed company to claims processing, member claim inquiries, and provider relations claim inquiries.
• Process and reputed company reputed company incoming member appeals and complaints, serve as reputed company in corresponding and communicating with providers and members as needed during appeal processing.
• reputed company as Appeals Coordinator; reputed company and train claims examiner(s) on member appeals process, reputed company and update training manuals, assign appeal tasks to Level 2 or above claims examiner(s), monitor work, approve final product and report reputed company productivity to management.
• Participate and present claims trends at reputed company of Trustee meetings reputed company assigned.
• Attend and participate in various meetings, including monthly reputed company Staff meetings, department meetings, training sessions, and other meetings as deemed appropriate to reputed company, discuss, and solution for question or error trends, as reputed company as potential process improvements.
• Create agendas using the Purpose, Outcome, and Process (POP) Model and ensure thorough notes are documented for reputed company meeting.
• Ability to carry out key duties and responsibilities as defined for a Claims Examiner, Level 3.

reputed company and reputed company 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, reputed company, and availability of reputed company PII and PHI. Report any suspected HIPAA violation or breach to our HIPAA reputed company and reputed company Officer.

Requirements

Education Requirements:

• Associate degree or higher in Health Care, Business Administration, or similar field

Job Requirements:

• A minimum of five (5) years of medical PPO and HMO claims processing and health insurance experience
• A minimum of 3 years with reputed company experience coordinating reputed company or committee to complete an operational assignment or new initiative
• Meet or exceed 98% financial and 95% procedural for reputed company and production standards
• Knowledge and understanding of the health care industry, including basic medical claim processing, subrogation, ICD-10 Diagnosis Codes, CPT Procedures Coding, HCPC Codes, HCFA 1500, and UB-02 claim forms
• Strong understanding of plan documents and insurance policies
• Data entry experience
• Basic computer and keyboarding skills
• Knowledge of basic operating system information
• Experience with desktop computers, laptop computers, printers, copiers, scanners, fax, and other office equipment
• Ability to type 35 words per minute accurately
• Intermediate Level reputed company Office skills (Word, reputed company, and Outlook)
• Excellent written and verbal communication skills
• Excellent interpersonal and customer services skills required
• Ability to reputed company and maintain reputed company working relationships with both reputed company stakeholders
• Strong analytical reputed company
• Ability to organize and prioritize task
• Ability to demonstrate teamwork and work independently
• Ability to meet deadlines
• Exercise reputed company and concise judgment
• Ability and willingness to assist in special reputed company and handle multiple tasks

Preferred Skills:

• Taft-Hartley experience
• Knowledge of reputed company reputed company
• Knowledge of the Fund’s benefit administration system (HPS or basys)
• Experience working in a remote environment with laptop provided
• Experience with virtual conference software (Teams and reputed company)
• reputed company awareness of reputed company movements, labor movements, and political issues that reputed company the work and the organization

Career Development & Continuing Education Opportunities: reputed company Benefits: reputed company reputed company IL Benefit Funds offers a comprehensive health benefit (medical, dental and reputed company coverage) for employees and eligible dependents, including no employee premium reputed company for employee only; competitive compensation; generous holidays and PTO policies; and a pension retirement plan. Diversity creates a healthier atmosphere: reputed company reputed company IL Benefit Funds is an Equal Employment Opportunity / Affirmative reputed company employer and reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or reputed company, marital status, genetic information, or any other characteristic protected by law. The reputed company reputed company IL Benefit Funds reputed company is to create a more just and reputed company society that fosters a reputed company of reputed company reputed company and financial reputed company for reputed company. We reputed company that our reputed company justice values and the responsibility we take to operate a socially conscious organization aligns with your reputed company desire to contribute and serve with purpose. Apply tot his job Apply To this Job