An opportunity to work for one of the top rated companies in WNY.
$14/hr, Temporary to possible permanent
This individual will be responsible for basic claims adjudication, performing basic claim adjustments and working defined reports. They are responsible for carrying out the necessary investigation of basic benefit concepts, other insurance, diagnosis of potential workers’ compensation, motor vehicle accidents, liabilities, assistant reports, as well as, processing basic Siebel service requests and Health Rules workbasket follow up items for both individual and department queues. This position will also be responsible for achieving departmental savings targets associated with coordination of benefits, which contributes to the overall organizational savings plan and medical loss ratio.
- High School diploma or GED required; Associates Degree preferred
- Experience with secondary payer process and procedures preferred
- Experience applying COB against NYS Rules and Regulations, NAIC Guidelines and CMS Guidelines preferred
- Solid verbal, written and interpersonal communication skills, with proven customer service skills. Customers can include, but is not limited to; a member, provider, attorney, employer group or another insurance company
- Proficiency with data entry skills and Microsoft Office (Word, Excel) products required
- Demonstrated experience with independent decision making to include effective problem resolution
- Assume responsibility and adhere to departmental deadlines and turnaround times, in order to be compliant with State and Federal regulations.Basic organizational skills with attention to detail and follow through
- Ability to work collaboratively within and outside of the Department