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Associate Claims Processor - Military Veterans

Company: Highmark Health
Location: Providence
Posted on: June 21, 2022

Job Description:

MILITARY VETERANS **Company :**United Concordia Dental**Job Description :****JOB SUMMARY**This job screens, reviews, evaluate online entry, error correction and / or quality control review and final adjudication of paper/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures. May include initial entry claims or claims which have suspended. Translate foreign language claims into English using software and code appropriately. Convert foreign currency to US dollar and code charges appropriately. Reviews processed claims and inquiries to determine corrective action which can include adjusting claims. Takes the corrective action steps using enrollment, benefit and historical claim processing information.**ESSENTIAL RESPONSIBILITIES:**+ Determine if claim information is complete and correct. Enter/verify claims data.+ Resolve claim edits, review history records and determine benefit eligibility for service. Review payment levels to arrive at final payment determination.+ Meets all production and quality standards. Attends all required training classes.+ Elevates issues to next level of supervision, as appropriate.+ Maintains accurate records, including timekeeping records.+ Other duties as assigned or requested.**EDUCATION****Required**+ High School Diploma/GED**Substitutions**+ None**Preferred**+ None**EXPERIENCE****Required**+ None**Preferred**+ 0-1 years of claims processing+ Typing speed of at least 60 words per minute**LICENSES or CERTIFICATIONS****Required**+ None**Preferred**+ None**SKILLS**+ Ability to take direction and to navigate through multiple systems simultaneously.+ Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.+ Ability to use mathematics to adjudicate claims.+ Ability to solve problems within pre-defined methods and guidelines.+ Knowledge of operating systems specific to claim processing.**Required**** Due to Department of Defense (DOD) contract requirements, the incumbent who fills this position must be a US citizen, and must also pass a background check ****Language (Other than English):**None**Travel Requirement:**0% - 25%**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS****Position Type**WFA - Work From Anywhere100% - RemoteTeaches / trains others regularlyNeverTravel regularly from the office to various work sites or from site-to-siteNeverWorks primarily out-of-the office selling products/services (sales employees)NeverPhysical work site requiredYesLifting: up to 10 poundsConstantlyLifting: 10 to 25 poundsOccasionallyLifting: 25 to 50 poundsNeverReferral Level 1:**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.__As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.__Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements_ .Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.EEO is The LawEqual Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( _)We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.For accommodation requests, please contact HR Services Online at HRServices@California Consumer Privacy Act Employees, Contractors, and Applicants NoticeReq ID: J208623

Keywords: Highmark Health, Providence , Associate Claims Processor - Military Veterans, Other , Providence, Rhode Island

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