Associate Claims Processor - Highmark Health

**Company :** United Concordia Dental **Job Description :** **JOB SUMMARY** ********* ******* **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** ******* This job is responsible for screening, reviewing, evaluating online entry, correcting errors and/or performing quality control review and final adjudication of paper/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Reviews processed claims and inquiries to determine corrective action and takes the corrective action steps using enrollment, benefit, and historical claim processing information. **ESSENTIAL RESPONSIBILITIES:** + Receives and processes claims to include entering/verifying claims data; determines if claim information is complete and correct. (40%) + Resolves claim edits, reviews history records and determines benefit eligibility for service. Reviews payment levels to arrive at final payment determination; elevates issues to next level of supervision, as appropriate. (35%) + Meets all production and quality standards, ensuring timeliness and accuracy of all work given by support staff/management. Maintains accurate records including timekeeping records. (15%) + Attends all required training classes. (10%) + Other duties as assigned or requested. ? **EDUCATION** **Required** + High School Diploma/GED **Substitutions** + None **Preferred** + None **EXPERIENCE** **Required** + None **Preferred** + 1 year of related experience ? **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. + Ability to thoroughly read guidelines ensuring claim accuracy and following directions. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Never Travel regularly from the office to various work sites or from site-to-site Never Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Never **_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_ . **Pay Range Minimum:** $18.00 **Pay Range Maximum:** $21.56 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ 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 Law Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( _https://www.eeoc.gov/sites/default/files/migrated\_files/employers/poster\_screen\_reader\_optimized.pdf_ ) 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@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J249381