Claims Specialist

Portsmouth, NH 03801

Posted: 09/06/2018 Industry: Customer Service Coordinator Job Number: 3357904
The Claims Specialist is responsible for the timely processing and follow-up on medical claims submitted to insurance companies and other entities for payment.ESSENTIAL DUTIES AND RESPONSIBILITIES: Core duties and responsibilities include the following: Submit on a timely basis to insurance companies medical claims for processing. Follow up with all payers to validate submission of hospital or physician status forms within adjudication process. Follow up on unpaid claims within standard billing cycle time frames. Call insurance companies regarding payments and denials to check on status and obtain EOBs. Identify and bill secondary or tertiary insurances. Answer all patient or insurance company telephone inquiries pertaining to assigned accounts. Balance new work and follow up accounts within workload. Perform other duties as assigned.COMPETENCIES: To perform the job successfully, an individual should demonstrate the following competencies: Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; Solicits customer feedback toimprove service; Responds to requests for service and assistance; Meetscommitments. Teamwork - Balances team and individual responsibilities; Exhibitsobjectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team aboveown interests; Able to build morale and group commitments to goals andobjectives; Supports everyone's efforts to succeed. Quality - Demonstrates accuracy and thoroughness; Looks for ways toimprove and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Quantity - Meets productivity standards; Completes work in timely manner; strives to increase productivity; Works quickly. Ensureswork responsibilities are covered when absent; Arrives at meetings andappointments on time. Dependability - Follows instructions, responds to management direction; takes responsibility for own actions; Keeps commitments; Completes tasks on time or notifies appropriate person with an alternate plan.EDUCATION AND/OR EXPERIENCE: Minimum of a High School diploma or general education degree (GED) is required. Minimum of one year office or customer service experience is desirable. Knowledge of general medical insurance processing guidelines is desirable.SKILLS/KNOWLEDGE: Proficient in Microsoft Office Suite and knowledge of database software and the internet.Clear and concise verbal and written communication skills

Delsin Grubbs
Senior Recruiter

Delsin began working with The Panther Group in 2007. He left for a few years, then returned as a recruiter in 2013 after coaching high school football and winning a state championship with that team. He is father to a 14-year-old sophomore in high school.

Delsin loves all food, but eats sushi 2-3 times a week.

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