Highly specialized job function that is responsible for claim analysis and claim processing for long term care services. This position is also accountable for reviewing claims for accuracy, timeliness, completeness and eligibility for multiple groups with varied benefits..
Job Responsibilities
Analyze and process claims in a productive environment through our TLC claim system, SIR, plan specs and
specimen policy
Appropriately interpret a variety of plan provisions and process claims accordingly, calculating claim payments and
overpayments
Review claims for receipt of all needed documentation and make outbound calls to providers for additional
information
Collaborate with our Claim Support Specialists, Customer Call Center and Care Coordinators to provide a seamless
claims experience
Abide by department guidelines and appropriately follow up on necessary tasks to process claims
Meet quality review standards of processed claims
Meet performance standards for financial accuracy, processing accuracy and claim timeliness
Respond to insured inquiries regarding specific claim details via telephone conversations and/or written
correspondence
Gather and analyze information skillfully to identify and resolve problems in a timely manner