Medical Claims Payer

I. JOB SUMMARY
The Medical Claims Processor will develop and direct the implementation of plans, policies, and programs affecting the organization’s relations with its employees and members.

II. ESSENTIAL DUTIES AND RESPONSIBILITIES

• Process medical claims as assigned.
  
• Clerical Duties as assigned for coverage in other departments.
  
• Verify eligibility to medical providers.
  
• Reviews provider requests for precertification and approves/denies as required.
  
• Maintain files as required.
  

III. COMPETENCIES

• Adaptability - Maintaining effectiveness when experiencing major changes in work responsibilities or environment (e.g., people, processes, structure, or culture); adjusting effectively to change by exploring the benefits, trying new approaches, and collaborating with others to make the change successful.
  
• Building Trusting Relationships - Using appropriate interpersonal styles to establish effective relationships with participants and internal partners; interacting with others in a way that promotes openness and trust and gives them confidence in one’s intentions.
  
• Collaborating - Working cooperatively with others to help a team or work group achieve its goals.
  
• Communication - Conveying information and ideas clearly and concisely to individuals or groups in an engaging manner that help them understand and retain the message, listening actively to others.
  
• Continuous Learning - Actively identifying new areas for learning; regularly creating and taking advantage of learning opportunities; using newly gained knowledge and skill on the job and learning through their application.
  
• Initiating Action - Taking prompt action to accomplish work goals; taking action to achieve results beyond what is required; being proactive.
  
• Work Standards - Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence rather than having standards imposed.
  

IV. MINIMUM REQUIREMENTS

• High School Diploma
  
• Verbal, written and interpersonal communication skills.
  
• Experience using MS Office applications (Word, Excel, Access and PowerPoint).
  
• No travel required.
  

V. PREFERRED QUALIFICATIONS

• Bachelor’s degree in business, Health Care, or related field.
  
• Three (3) years of experience in claims processing.
  

VI. WORKING CONDITIONS
This job operates in a professional office environment indoors. Routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.

VII. PHYSICAL DEMANDS
The position requires the ability to spend long hours sitting or standing while using office equipment and computers. Ability to perform repetitive tasks such as typing and keying. Occasional lifting, pushing/pulling, carrying 10 lbs. of supplies and materials is required.

COMPANY NAME: Local 710 Health Welfare and Pension Funds
JOB TITLE: Medical Claims Processor
REPORTS TO: Claims Manager
DEPARTMENT: Claims

The above statements are intended to describe the general nature and level of work being performed by individual(s) assigned to this job. It is not intended to be an exhaustive list of all duties and responsibilities required of individual(s) in this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties and responsibilities of this job.