Job description

Job Summary: Our claims operations are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's a fast-paced challenge. It's a job that calls you to be thoughtful, resourceful, team driven, and customer focused. This position requires strong customer service skills to effectively provide high quality service as well as maintain health plan relationships. This position must work with internal customers in a courteous and compassionate manner with attention to accuracy and quality. This role will require being on phone at least 50% of the time.

Primary Responsibilities:

• Provide expertise or general claims support by reviewing, researching, investigating, processing and adjusting claims.
• Analyze and identify trends and provider reports as necessary
• Consistently meet established productivity, schedule adherence, and quality standards.
• Read and understand plan documents, networks, contracts etc.
• Apply refund and overpayment to claims as needed
• Apply appropriate fee schedules and rates to claims
• Basic tasks are completed without review by others
• Supervision/guidance is required for higher level tasks.

Qualifications:

• High School diploma or GED required
• Ability to work anytime between M-F 8:00- 5:00 pm required
• 1 year Claims Examiner experience
• Previous experience with MS Office software-required
• Medicare guideline and regulation knowledge
• Basic 5010 experience
• Additional education completed with concentration in Healthcare industry preferred
• 1 year professional office experience within the health care insurance claims industry required
• 1 year Customer Service experience

Supervisory Responsibilities: None

Working Conditions/Physical Requirements: This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.

HealthTexas is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, genetic data or other legally protected status.

Health Texas is a drug-free and tobacco-free workplace, with a nicotine-free hiring policy. Nicotine includes all tobacco products including cigarettes, cigars, pipe tobacco, snuff, chewing tobacco and electronic cigarettes.

In order to be qualified for employment candidates must successfully complete a background investigation and comply with HealthTexas’s COVID-19 vaccination requirement.

Job Type: Full-time

Benefits:

• Health insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: In person

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