Claims Payment Specialist

We are hiring for a Claims Payment Specialist to join the team in our King of Prussia, PA office! This position analyzes returned payments received as a USD check or electronically thus verifying electronic payment information and/or address information to determine the extent of reimbursement to ensure the insurance carrier's settlements are in accordance with policy provisions in an accurate and timely manner, while adhering to GeoBlue/HTH Worldwide Insurance Services processing standards and turnaround requirements.

Responsibilities:

• Analyzing and comparing claim payment information initiated on the international claim invoice to determine cause of returned payment.
• Identify and correct payment details on all returned claim reimbursements. This includes, but is not limited to returned, failed, and rejected electronic payments, suspended electronic payments, and returned checks.
• Act as direct liaison between internal departments to provide amended instructions for claim reimbursements.
• Initiate contact with members and healthcare providers regarding valid electronic payment information and current mailing address.
• Request wire tracers from the finance department to locate payments for inquiries received through the Salesforce cases.
• Analyze and identify refund payments received from members and/or healthcare providers for inaccurate/overpayments made and requesting said claims to be credited for the received amounts.
• Maintain department production and quality standards.
• Obtains information necessary to properly act upon the claim payment information and maintains appropriate written records of statements and facts relating to the claims.
• Keep supervisor advised of status of workload and identify problems for which help is needed.
• Follow regulations and company rules and policies as outlined in the Employee Handbook.
• Other duties as assigned.

Requirements:

• High school diploma or equivalent. Some college/degree a plus.
• Minimum - one to two years' experience in a customer facing role prefer with exposure to accounting or finance activities.
• Ability to use automated enrollment processing software and automated claims adjudication software.
• Good verbal and written communication skills and the ability to effectively deal with customer complaints and concerns.
• Work organization, problem solving, data entry, and basic math skills.
• Ability to make decisions and support them with documentation.
• Knowledge of, and the ability to learn Microsoft Office Products, internal software systems, the internet and overall familiarity with personal computers.
• Knowledge of administrative/clerical procedures.
• Employee is required to have at minimum an internet speed of 75 Mbps (standard high-speed internet access).

Working Conditions:

• Flexibility to work in an office and/or at-home, remote office environment.
• Overtime and/or schedule flexibility are occasionally necessary in this position. Individual may be required to attend key business/departmental meetings and/or perform certain business critical job functions outside of normal working hours.
• Physical Demands: Must be able to communicate internally and externally through receiving and responding to auditory and visual methods.

Competitive base pay starting at $18.15/hr.

Compensation is based on prior/relevant experience and skill level in a similar role.

This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned.