This position works in our Plan Build Department maintaining system configuration used to process claims in the GBAS operating system.
Successful candidates will have experience in Medical Claims Adjudication, Claim Benefits, Provider Updates, and Customer Care systems, or related claims processes,
and will have experience in Medical Claims processing, coding and/or customer service experience for a minimum of one year in the Third-Party Administrator (TPA) business.
Key Result Areas
Administer plan benefits based on documentation received.
Participate in plan implementation with key departments such as Administration, Claims, Customer Care, and Account Management.
Play an active role in plan administration by providing technical support for multiple departments.
Identify and expedite issues regarding plan design and interpretation of benefits to appropriate management personnel. Respond to 1st and 2nd level-escalation claim issues within 24-48 hours.
Work route QUE on a daily basis, adherence to 24-48-hour turnaround.
Regularly update and maintain tables essential for claims adjudication i.e. PDCRM, ACNM, AAPM, AC, CFEEM, and many more.
Perform integrated audit and/or pre and post testing on plan design, networks, and implementations.
Enter plan information accurately and efficiently into the claims system.