[Hiring] Claims Processor / Customer Service Rep @WM MICHAEL STEMLER INC

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This position involves evaluating claims and providing customer service support. • Evaluate claims and determine payment or denial according to Plan provisions, Medical Policy and Department guidelines • Key all final information for claims release into computer • Respond to telephone customer inquiries verifying eligibility, explaining coverage, quoting benefits and advising on the status of claims • Maintain information files, worksheet records, benefit quote documentation • Establish and maintain COB files, applies COB payments for final claim payment • Research and determine proper CPT procedure and ICD-9 Diagnosis Codes • Research and respond to written correspondence from participants, providers, and local unions/employers • Prepare transmittal and send claims to Benefit Review for processing instructions • Work effectively to achieve acceptable production and accuracy standards • Display maturity, composure and ability to operate under stress conditions • Perform other duties as assigned • Specialty duties include: Enter dates of service on dental pre-determinations, process voided checks and refund checks, maintain weekly disability files and process claims Qualifications • Eighteen (18) months experience as a Claims Processor or similar function • Broad knowledge of medical terminology • Excellent written and oral communication skills • Good judgment skills and ability to interpret Department guidelines and contractual benefits • High school diploma or equivalent • Satisfactory completion of medical terminology course may substitute for six (6) months of equivalent experience Company Description Delta Health Systems is committed to long-term growth, employee development and superior client service. Join a great team with terrific total comp package. Equal Opportunity Employer Apply tot his job