Job Title: Claims Coordinator
Department: Claims
Reports To: Claims Supervisor
CSTS (supporting Ultimate Health Plans) is seeking a dedicated and detail-oriented Claims Coordinator to support the daily administrative functions, communications, and correspondence of our claims department. The ideal candidate will work with internal and external departments and providers on claims-related content, ensuring timely and accurate processing of all claims.
Remote position but Florida-based candidates heavily preferred.
Essential Duties and Responsibilities:
- Collaborate with internal and external departments and providers on claims-related matters.
- Provide timely follow-up on provider callbacks.
- Perform data entry for paper claims for all D-SNP members and batch non-D-SNP paper claims for the appropriate team.
- File important emails in appropriate e-files within Outlook and report claims escalations to the Claims Operations Supervisor.
- Assist with responding to customer service/MAT team inquiries via call routes.
- E-file requests for direct member reimbursement and redirect them to the appropriate team member/department.
- Maintain physical copies of all paper correspondence received by the claims department.
- E-file medical records received for review and redirect them to the appropriate team member/department.
- Manage the overpayment letter tracker, ensuring timely mailing and notifying the appropriate team member when letters age to 45 days.
- Work incoming mail and scan documents for internal or other area sharing.
- Communicate process changes, project status, and issue resolutions through email, group presentations, and individual meetings.
- Handle undeliverable mail, verify and update mailing addresses for providers, including making outbound calls to request updated W-9s and uploading them to the provider management system.
- Interface with providers via telephone and written correspondence to respond to inquiries and resolve concerns.
- Perform other duties as assigned or needed.
Competencies:
- Analytical Skills: Synthesize complex information, collect and research data, and demonstrate attention to detail.
- Problem Solving: Identify and resolve problems timely, gather and analyze information skillfully, develop alternative solutions, and work well in group problem-solving situations.
- Customer Service: Manage difficult or emotional customer situations, respond promptly to customer needs, solicit feedback to improve service, and meet commitments.
- Interpersonal Skills: Focus on solving conflict, maintain confidentiality, listen without interrupting, remain open to others' ideas, and try new things.
- Communication: Speak clearly and persuasively, respond well to questions, write clearly and informatively, edit work for spelling and grammar, and present numerical data effectively.
- Teamwork: Balance team and individual responsibilities, exhibit objectivity and openness to others' views, contribute to building a positive team spirit, and support everyone's efforts to succeed.
Qualifications:
- Education and/or Experience: High School Diploma or GED Equivalent required. At least 3 years of previous experience in Managed Care and Medicare preferred.
- Language Skills: Ability to read and interpret documents, write routine reports and correspondence, and speak effectively before groups.
- Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, compute rate, ratio, and percent, and draw and interpret bar graphs.
- Reasoning Ability: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions and deal with problems involving a few concrete variables in standardized situations.
- Computer Skills: Expert working knowledge of Microsoft Office software, including Excel and Word, as well as MS Internet Explorer.
Job Type: Full-time
Pay: $15.32 - $18.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- Day shift
- Monday to Friday
Work setting:
Experience:
- Microsoft Office: 1 year (Required)
- Customer service: 1 year (Required)
Work Location: Remote