This position will support all administrative processes related to Claims, including Document Capture, Document Indexing, and Claim Analyst processes.
Requirements
- Ensure that Claim documents were correctly categorized for processing in XBound
- Scan any claim documents received via mail
- Work closely with the data capture representatives to resolve any issues that might arise
- Set up new claims as needed for clients that submit claims as individual initial notices / request for payment
- Verify that all documents attached to the claim are correctly indexed
- Verify that all information entered is accurate to ensure that any auto-adjudicated claims are paid correctly
- Review, enhance, and sign settlements ensuring client payments and refunds are processed timely
- Produce and provide claim reports to clients as needed
- Monitor workflow and identify potential claims processing issues
- Assess and clear claims held in verification / pending claim status
- Work cross-functionally to resolve system impediments to claim payment processing
- Prepare weekly, monthly and quarterly paid claim and WIP reports
- Establish requirements for system enhances and log tickets for tracking, testing, and implementation
- Analyze client trending analyses to understand financial results and identify potential future impact
- Assist with internal and external audits
- Produce ad-hoc reports for management and other members of the organization as needed
- Produce claims metrics reports as required
- Identify opportunities for improvement and implement solutions