Claims Clerk, Sr. reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary. Inputs claim information into system for processing. Being a Claims Clerk, Sr. verifies coverage eligibility. Calculates settlement amounts according to guidelines. Additionally, Claims Clerk, Sr. processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. The Claims Clerk, Sr. works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Claims Clerk, Sr. typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
Description
SEIU Healthcare IL Benefit Funds is a dynamic healthcare organization committed to providing the highest quality health and retirement benefits in the most financially responsible manner, while always acting in the best interest of the union members. We serve over 20,000 union workers in the Nursing Home, Home Care, Child Care and Personal Assistance industries with health and pension benefits. Our employees epitomize the Fund’s core values of quality service, interdependence, effectiveness, and accountability through the alliance to each other, the organization and those we serve.
Position Summary:
The Claims Clerk is responsible for managing and monitoring claims clerical functions within the Medical Benefits & Claims department and for providing general claims support to the claims team.
This position will work closely with the claims team members as well as other department staff throughout the organization. Communication with both external and internal stakeholders and providing excellent customer service is vital for this role.
The Claims Clerk will be responsible for the following:
Key Duties and Responsibilities:
Privacy and Security Responsibilities:
This position requires employee to handle Personal Identifiable Information (PII) and Protected Health Information (PHI) for our members. You will be responsible and accountable for maintaining the confidentiality, integrity, and availability of all PII and PHI. Report any suspected HIPAA violation or breach to our HIPAA Privacy and Security Officer.
Requirements
Education Requirements:
Job Requirements:
Preferred Skills:
Physical Demands:
Career Development & Continuing Education Opportunities: Yes
Benefits:
SEIU Healthcare IL Benefit Funds offers a comprehensive health benefits (medical, dental and vision coverage) for employees and eligible dependents, including no employee premium option for employee only; competitive compensation; generous holidays and PTO policies; and a pension retirement plan.
Diversity creates a healthier atmosphere: SEIU Healthcare IL Benefit Funds is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
The SEIU Healthcare IL Benefit Funds vision is to create a more just and equitable society that fosters a lifetime of quality healthcare and financial security for all. We hope that our social justice values and the responsibility we take to operate a socially conscious organization aligns with your professional desire to contribute and serve with purpose.