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Claims Management Processor

Job Level:  Entry Level
Location: 

QA

Due Date:  As soon as possible
Area of Expertise:  Operations
Unit:  Allianz Partners
Job Type:  Full-Time
Remote Job:  Not applicable
Employment Type:  Permanent
ID:  2481
Claims Management: 
• Ensures that insurance claims information is entered into the system correctly, to ensure accurate processing and timely payment.
• Ensures that provider’s fees and service items charges coincide with their existing contract price list with NEXtCARE.
• Ensures the accuracy of the entered data as per the existing standard steps and procedures of direct claims processing.
• Compares data on claims applications.
• Screens claim documents and process claim adjustment.
• Ensures Payment Orders are properly created and forwarded accordingly for final documentation and filing.
• Ensures adaptability in various work-related tasks to be able to facilitate a multi-tasking role.
• Ensures that high quality standard of work performance is achieved at all times.
 

Filing/Monitoring

• Stands as a reference person for information on inquiries concerning claims processing procedures.
• Monitors correct application of beneficiary share accordingly on service items billed.
• Makes sure that claims are properly audited of all data entered with accurate medical claims details.
• Notes all discrepancies during the course of the system process are properly forwards and notifies to immediate supervisors.
• Provide requisition of office supplies for Individual and Team requirement.

 

Other Duties

• Researches claims as needed
• Obtains and audit medical records to compute and record patient charges.
• Performs other related duties incidental to the work described herein.