Claim Technician

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Job Summary

Under supervision, this position is responsible for processing complex claims requiring further investigation, including coordination of benefits and resolving pended claims. The Claim Technician is responsible for reviewing, processing, and adjudicating healthcare claims accurately and efficiently in accordance with company policies, payer guidelines, and regulatory requirements. This role investigates claim discrepancies, researches denials, verifies member and provider information, and ensures timely claim resolution. The Claims Technician also collaborates with internal departments, providers, and members to resolve claim issues while maintaining high standards of accuracy, productivity, compliance, and customer service. The ideal candidate demonstrates strong analytical skills, attention to detail, and knowledge of healthcare claims processing, medical terminology, and applicable regulations, including HIPAA. Starting pay falls between: $17.75 to $18.25, commensurate with experience

NOTE: there is a mandatory six-week onsite training with strict attendance requirements which occurs Monday-Friday (8am to 5pm). Upon successful completion of this training, work from home provisions will be established.

JOB REQUIREMENTS

• High School diploma or GED.
• Solid data entry and/or typing experience.
• Proficiency in Microsoft Office Suite, including Excel for data review and reporting.
• Clear and concise written and verbal communication skills.
• Experience processing medical claims with the ability to manage high-volume workloads while maintaining quality metrics.
• Strong attention to detail, problem-solving, and organizational skills.

PREFERRED REQUIREMENTS

• Must have trained on the six or eight-week Blue Chip claims processing system or have the ability to fully complete the six or eight-week Blue Chip Training class.
• Knowledge of medical terminology and CPT, HCPCS, and ICD9 coding.
• Knowledge of coordination of benefits principles and terminology.
• Familiarity with claims adjudication systems and healthcare payer processes.
• Experience with multi-tasking and prioritizing.

~ KEY FUNCTIONS ~

• Process complex claims in various queues. Conduct research and investigation into missing information, make phone calls to providers (as necessary), access resource materials and support files in order to process and adjudicate claims timely and accurately.
• Resolve complex pended claims, duplicate claims and adjustments.
• Process claims, involving communications with participating plans and/or Service Units. Resolve various issues.
• Research and identify other insurance, Medicare, Medicaid and update patient file as needed.
• Coordinate benefits; request explanation of benefits as needed.
• Maintain a working understanding of medical terminology and CPT, HCPCS, and ICD9 coding.
• Maintain knowledge related to specific contracts.
• Read appropriate files in IMAGE and apply information to claims as needed using the Financial Suspense System (FSS).
• Learn and maintain knowledge of DOL ERISA and prompt pay legislation.
• Periodic overtime may be required at the sole discretion of the employer based on business need.

NOTE: there is a mandatory six-week onsite training with strict attendance requirements which occurs Monday-Friday (8am to 5pm). Upon successful completion of this training, work from home provisions will be established.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

Exact compensation may vary based on skills, experience, and location.