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The Claims Processing Representative 2 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Processing Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.
Claims Processing Representatives (claims processors) are part of a claims processing team in support of the TRICARE contract. Claim processors typically work on routine and patterned assignments to make appropriate claim decisions based on strong knowledge of claims procedures, contract provisions, TRICARE Policy, and state and federal legislation. Claim processors also perform advanced operational and customer support duties that require independent initiative and judgment.
Analyze claims to determine if eligibility, preauthorization and other claim filing requirements are met and make determinations. Identify when to pend to other departments based on guidelines. Translate, research, and verify claim information to determine if all requirements have been met.
Determine corrective action to be taken on various types of errors pended by the system and resolve interactive edits.
Contact providers and beneficiaries for missing claim information to process the claim through.
Interface and work with other HMHS departments, WPS, and MTF/TRO customers to seek problem prevention and resolution.
U.S. Citizenship is required by our Department of Defense contract
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
High School Diploma or GED
Claims Processing experience
Ability to understand claims adjudication, systems and reporting
Ability to manage and prioritize multiple initiatives with minimal guidance
Ability to promote teamwork and build effective relationships while meeting objectives
Excellent written and verbal communication skills and strong customer service skills
Ability to take initiative and meet objectives
High level of problem-solving and analytical skills
Ability to read and interpret documents such as contracts and operations manuals
Knowledge of HIPAA regulations
Intermediate typing skills
Proficient in Microsoft Office products, such as Word, Excel and Outlook
Associate's Degree or Bachelor's Degree
Medical billing/coding experience
Knowledge in healthcare business applications and technology
Medicare and/or TRICARE experience
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Text to enhance our hiring and decision-making ability. Montage Text allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive a correspondence inviting you to participate in a Montage Text interview. In this interview, you review a set of interview questions over your phone and you will provide text responses to each question. You should anticipate this interview to take about 15 to 20 minutes. Your text message interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
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