What are the responsibilities and job description for the Claims Processor position at Aston Carter?
*Remote position to WI residents only and is a temporary position*
Description:
Hiring Claims Resolution Specialists for a contract that is supporting Humana Tricare. We process all of Humana Tricare claims - which is the insurance available for active duty military, veterans, and their families.
The claims resolution department handles all Tricare claims that come through that don’t "process cleanly." A lot of claims are processed automatically if they are 100% correct. The claims resolution team will review all of the claims that are not automatically processed due to something being off (wonky) or needing more information.
They will get trained on the most basic type of claim edit first which is finding valid beneficiaries to match to the claim. A beneficiary is a person or a legal entity that is designated by you to receive a benefit (ex: the active duty member holds the policy but his family has Tricare insurance as well; they are the beneficiaries)
Need to research certain things- example - maybe the same name or social security is different, make sure they are paying attention to those details
Some staff will start to get trained on handling different claim edits. A few examples are below:
1. System mistranslated a type of bill, they will need to check the claim image to verify
2. Looking at something like the claim is trying to deny but there is a lot amount on the line
3. Beneficiary matching / errors
4. Provider submitted the wrong modifier and the claims rep needs to go in and fix this
5. To process Third Party Liability (TPL) claims and provide information and support to the Judge Advocates General (JAG) Offices, insurance companies, attorneys, and providers in accordance with TRICARE regulations and guidelines.
They will eventually start to cross-train these staff in various other areas like OHI (other health insurance) and manually pricing a claim
THIS IS A HIGH-VOLUME PRODUCTION ENVIRONMENT.
Skills:
Claim, Claims processing, Insurance, Data entry, Health insurance, JAG, Judge Advocates General, Insurance Companies, Customer service
Additional Skills & Qualifications:
- Ability to research on their own to figure a process out - for example: they have training manuals that outline how to handle specific claims and they expect their claims reps to research this to try and figure it out on their own
- Strong computer skills - both data entry and navigation
- Ideally, I want candidates with claims processing experience/background; however, they will take candidates with no experience - bartenders and servers have worked out well as long as they are technologically savvy
About Aston Carter:
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At Aston Carter, we’re dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions – from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless.
Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients’ capabilities by seeking solvers and delivering solutions to address today’s workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit AstonCarter.com. Aston Carter is a company within Allegis Group, a global leader in talent solutions.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email astoncarteraccommodation@astoncarter.com for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.
Salary : $20
