Claims Processing Clerk, Sr. receives and inputs new healthcare claims, processes payments, conducts billing research, and responds to telephone inquires. Evaluates claims and administers payment, denies, or returns claims according to policy provisions and organizational guidelines. Being a Claims Processing Clerk, Sr. produces routine and ad hoc reports. Requires a high school diploma. Additionally, Claims Processing Clerk, Sr. typically reports to a supervisor. The Claims Processing Clerk, Sr. works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. To be a Claims Processing Clerk, Sr. typically requires 3-5 years of related experience. (Copyright 2024 Salary.com)
MMG INSURANCE COMPANY
Job Description
Job Title: Claims Processing Clerk
Department: Casualty Claims
Reports To: Manager
FLSA Status: Non-Exempt
SUMMARY
Supports Claims staff by performing clerical functions such as indexing, keying payments and notices; updating and maintaining loss notices, and related documentation.
ESSENTIAL DUTIES AND RESPONSIBILITIES
SUPERVISORY RESPONSIBILITIES
This job has no supervisory responsibilities.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
Associate's degree; or equivalent combination of education and experience.
LANGUAGE SKILLS
Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings; Writes clearly and informatively; Edits work for spelling and grammar; Able to read and to interpret written information.
MATHEMATICAL SKILLS
Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions and decimals. Ability to compute rate, ratio and percent.
REASONING ABILITY
Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem-solving situations; Uses reason even when dealing with emotional topics.
COMPUTER SKILLS
To perform this job successfully, an individual should have knowledge of Office Productivity software such as Spreadsheet, Word Processing, and Communication software, and claims-related processing software.
CERTIFICATES, LICENSES, REGISTRATIONS
The Company may require the employee to acquire, within a reasonable period of time as established by the Company, adjusters’ licenses in all states in which the Company does business.
The Company may expect the employee to acquire the Associate in Insurance Claims (AIC) designation sponsored by the Insurance Institute of America.
The Company may expect the employee to take other courses it deems appropriate to the employee's duties and responsibilities.
OTHER SKILLS AND ABILITIES
OTHER QUALIFICATIONS
Teamwork – Balances team and individual responsibilities; Exhibits objectivity and openness to others’ views; Gives and welcomes feedback; Contributes to building a positive team spirit.
Demonstrates an aptitude consistent with securing information, analyzing it, and making above-average decisions affecting the position's area of responsibility.
Judgment – Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee is occasionally required to stand; walk; reach with hands and arms. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is occasionally exposed to outside weather conditions. The noise level in the work environment is usually quiet.