Claim Technician

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career. Come join us and be part of a purpose driven company who is invested in your future! Job Summary Under Supervision, This Position Is Responsible For Processing Complex Claims Requiring Further Investigation, Including Coordination Of Benefits And Resolving Pended Claims. Responsibilities * Process complex claims in various queues. Conduct research and investigation into missing information, make phone calls to providers (as necessary), access resource materials and support files in order to process and adjudicate claims timely and accurately. * Resolve complex pended claims, duplicate claims and adjustments. * Process claims, involving communications with participating plans and/or Service Units. Resolve various issues. * Research and identify other insurance, Medicare, Medicaid and update patient file as needed. * Coordinate benefits; request explanation of benefits as needed. * Maintain a working understanding of medical terminology and CPT, HCPCS, and ICD9 coding. * Maintain knowledge related to specific contracts. * Read appropriate files in IMAGE and apply information to claims as needed using the Financial Suspense System (FSS). * Learn and maintain knowledge of DOL ERISA and prompt pay legislation. * Periodic overtime may be required at the sole discretion of the employer based on business need. Required Job Qualifications: * High School diploma or GED. * Data entry and/or typing experience. * Clear and concise written and verbal communication skills. * Experience processing medical claims. Preferred Job Qualifications: * Referral preference given to applicants able to take and meet testing criteria. * Must have trained on the six-eight-week Blue Chip claims processing system or have the ability to fully complete the six-eight-week Blue Chip Training class. * Knowledge of medical terminology and CPT, HCPCS, and ICD9 coding. * Knowledge of coordination of benefits principles and terminology. * Experience with multi-tasking and prioritizing. Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! HCSC Employment Statement: HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.