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Medical Claims Associate - Lincoln

Company: NRECA
Location: Lincoln
Posted on: January 11, 2019

Job Description:

Purpose & Mission The purpose of the job is to review, investigate, and analyze medical claim information for the NRECA membership. Is responsible for providing prompt and courteous customer service and information to plan participants, member systems, and service providers (physicians/hospitals/clinics), regarding NRECA's plans. Must adhere to call volume standards, claim production standards, and quality standards for claim benefit determination and payments. This position is the first level in the claim associate career ladder.Summary of Essential Functions Under supervision, investigates and analyzes medical claims and issues related to eligibility, benefit coverages, network, and pricing.Processes medical claims. Determines when to pay or deny claims and issues benefits while achieving the quality and daily production requirements. Answers incoming calls, emails, faxes, and written correspondence regarding customer inquiries or complaints with benefit correction requests. Analyzes and responds to requests for information and claim reconsideration reviews. Makes outbound calls to members or service providers as necessary. Position Reports to: Supervisor, Claims Regular Work Schedule - M-F, 8:15 a.m. - 5:00 p.m. with a rotating alternate work schedule of 9:15 a.m. - 6:00 p.m., 2-3 days per month Educational Requirements High School diploma or GED, Associate's degree preferred. Certification in a medical terminology course within six months of hire into the job. Experience RequirementsUp to 12 months experience in claims processing working with health insurance plans or in a healthcare billing office Knowledge, Skills, and Abilities Requirements (as demonstrated by prior work experience) Ability to perform and work on multiple tasks while being flexible and able to cope with changing conditions/policies/procedures in a fast-paced and sometimes intense working environment, while maintaining production and accuracy goals.Ability to communicate, both verbally and in writing, with a diverse membership, employees, and vendors in a clear and concise manner. Ability to perform mathematical calculations (addition, subtraction, division, multiplication, percentages).Ability to learn and use Microsoft Office (Excel, Word, Outlook) and other software tools in the day-to-day duties of the job. Ability to listen and interpret the customer's needs, de-escalate difficult customer calls while at the same time researching claim issues to meet the customer's satisfaction. Ability to work extended hours during the week and/or weekend hours Physical RequirementsThe worker is required to have close visual acuity to perform an activity such as preparing and analyzing data and figures, viewing a computer screen and extensive reading. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. The job is light duty work and is sedentary and doesn't require the use of arm and/or leg exertion greater than that for sedentary work.
Medical Claims Associate
Location: Lincoln
Category: Customer SupportJob DescriptionThe National Rural Electric Cooperative Association (NRECA), with offices in Arlington, VA and Lincoln, NE is the trade association for over 900 consumer-owned electric cooperatives serving more than 42 million people. NRECA is committed to harnessing the strength of America's electric cooperatives into a single powerful voice. NRECA has won the following awards over the past few years: --- Top Workplace by the Washington Post
--- 100 Best Places to Work - ComputerWorld Magazine
--- 50 Best Places to Work - The Washingtonian
--- CARE Award Recipient - Recognizing organizations that promote a positive work-life balance
--- Best Place to Work Award Recipient - Lincoln, NE
--- Gold Well Workplace - Wellness Councils of America
--- State of NE Governor's Wellness Award - Grower LevelAt NRECA, we work with people who are leaders in their fields. They are down-to-earth, hardworking professionals committed to helping our members serve their communities. Our work is interesting, constantly evolving, and requires new skills to meet the evolving needs of a dynamic industry. In this collegial, inclusive work environment, united around the compelling purpose and history of electric cooperatives, we thrive. And topping it off, NRECA cares about each person's overall well-being, encouraging health, financial security, and a sustainable work/life balance. EEO/AA- M/F/Disability/Protected Veteran Status/Genetic DataSummary of Medical Claims Associate
Purpose & Mission The purpose of the job is to review, investigate, and analyze medical claim information for the NRECA membership. Is responsible for providing prompt and courteous customer service and information to plan participants, member systems, and service providers (physicians/hospitals/clinics), regarding NRECA's plans. Must adhere to call volume standards, claim production standards, and quality standards for claim benefit determination and payments. This position is the first level in the claim associate career ladder.Summary of Essential Functions

  • Under supervision, investigates and analyzes medical claims and issues related to eligibility, benefit coverages, network, and pricing.
  • Processes medical claims. Determines when to pay or deny claims and issues benefits while achieving the quality and daily production requirements.
  • Answers incoming calls, emails, faxes, and written correspondence regarding customer inquiries or complaints with benefit correction requests.
  • Analyzes and responds to requests for information and claim reconsideration reviews.
  • Makes outbound calls to members or service providers as necessary. Position Reports to: Supervisor, Claims Regular Work Schedule - M-F, 8:15 a.m. - 5:00 p.m. with a rotating alternate work schedule of 9:15 a.m. - 6:00 p.m., 2-3 days per month Educational Requirements
  • High School diploma or GED, Associate's degree preferred.
  • Certification in a medical terminology course within six months of hire into the job. Experience Requirements
  • Up to 12 months experience in claims processing working with health insurance plans or in a healthcare billing office Knowledge, Skills, and Abilities Requirements (as demonstrated by prior work experience)
  • Ability to perform and work on multiple tasks while being flexible and able to cope with changing conditions/policies/procedures in a fast-paced and sometimes intense working environment, while maintaining production and accuracy goals.
  • Ability to communicate, both verbally and in writing, with a diverse membership, employees, and vendors in a clear and concise manner.
  • Ability to perform mathematical calculations (addition, subtraction, division, multiplication, percentages).
  • Ability to learn and use Microsoft Office (Excel, Word, Outlook) and other software tools in the day-to-day duties of the job.
  • Ability to listen and interpret the customer's needs, de-escalate difficult customer calls while at the same time researching claim issues to meet the customer's satisfaction.
  • Ability to work extended hours during the week and/or weekend hours Physical Requirements
  • The worker is required to have close visual acuity to perform an activity such as preparing and analyzing data and figures, viewing a computer screen and extensive reading.
  • Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects.
  • The job is light duty work and is sedentary and doesn't require the use of arm and/or leg exertion greater than that for sedentary work.

    Keywords: NRECA, Lincoln , Medical Claims Associate - Lincoln, Healthcare , Lincoln, Nebraska

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