Employee Benefit Management Services, Inc.
  • 16-Jan-2018 to 17-Mar-2018 (MST)
  • Claims
  • Billings, MT, USA
  • Hourly
  • Full Time

Generous Benefits Available

Job Summary:
This position compiles and maintains claims data and supports the Claims Department. This position also actively participates in service and quality assurance initiatives to assist the department in delivering high quality service. This position maintains a comprehensive understanding of the plan document(s) under their scope of responsibility.

Essential Duties and Responsibilities:
Claims Support
1.1. Contacts medical providers for information needed to complete claims processing.
1.2. Manages refund requests by managing refund database, following up with providers and members on refund requests, and follows-up with appropriate parties as necessary.
1.3. Manages and monitors HIPAA authorization requests.
1.4. Runs daily reports functions.
1.5. Manages and pays fees for outside repricing vendors
1.6. Maintains claims and ancillary databases
2.1. Maintains filing on and off site.
2.2. Sorts and distributes daily correspondence.
2.3. Prepares all outgoing mail for Claims Department.
2.4. Enters data into pertinent computer systems.
Claims/Fee Processing
3.1. Performs data entry and processes claims for miCare
3.2. Processes peer reviews
Rx Claims
4.1. Calculates daily online prescription claims.
4.2. Processes overpayments to member accounts.
4.3. Registers Rx claims manually as needed.
4.4. Processes PBM rebates
Customer Service
5.1. Acts as a role model in demonstrating the core values in customer service delivery.
5.2. Provides timely and thorough follow up with, internal and external customers.
5.3. Appropriately escalates difficult issues up the chain of command.
5.4. Trains new employees as assigned.
Quality Assurance
6.1. Serves on committees, work groups, and/or process improvement teams, as assigned, to assist in improving quality/customer satisfaction.
6.2. Recognizes and alerts appropriate supervisor of trends within their scope of responsibility that fall outside of quality parameters.
6.3. Performs self quality monitoring in order to develop and execute plans to meet established goals.
6.4. Provides ongoing feedback to help optimize quality performance.
6.5. Collaborates with others and cross-departmentally to improve or streamline procedures.
6.6. Develops new or improves current internal processes to improve quality
7. This job description in no way states or implies that these are the only duties to be performed by this employee. The employee will be required to follow any other instructions and to perform any other duties requested by his/her supervisor.

Minimum Qualifications:
• High school diploma or equivalent
• Minimum of 2 year's experience in clerical or customer service
• Prescription drugs, pharmacy or health care experience preferred
• Working knowledge of computers and software including but not limited to Microsoft Office products
• Proficient 10-key and typing skills
• Demonstrated organizational skills, problem-solving, analytical skills and detail oriented
• Strong written, oral and telephonic communication skills
• Demonstrated ability to work independently, prioritize workloads multi-task and manage priorities in order to meet deadlines

Physical Demands & Working Conditions:
Work is indoors in an office environment with moderate noise. Intermittent physical effort involving lifting of up to 25 pounds, walking, and stooping, kneeling, crouching, or crawling is required. A typical workday involves sitting, frequent use of a keyboard, reaching with hands and arms, and talking and hearing, approximately 70% of the time. Approximately 30% or less of the time is spent standing. Normal vision abilities required, including close vision and ability to adjust focus.

Employee Benefit Management Services, Inc.
  • Apply Now

  • * Fields Are Required

    What is your full name?

    How can we contact you?

    By clicking the button above, I agree to ApplicantPro's Applicant Information Use Policy.

  • Sign Up For Job Alerts!

  • Share this Page
  • Facebook Twitter LinkedIn Email
Logo Home About Us Forms/FAQs News/Events Contact Linked In You Tube Login Members Employers Brokers Providers Learn More