JOB DESCRIPTION

CLAIM TECHNICIAN / ADMINISTRATION SUPPORT - FULL TIME

The Illinois Life & Health Insurance Guaranty Association Claim Technician and Administration Support complements team members in various ways including the investigation of medical, behavioral, and long-term care health claims and death benefit claims.  This position works in conjunction with the claims team and utilizes policies and procedures to perform adjudication, adjustments and audits of claims, ensuring accuracy of payment details.  This position is the point person to ensure that claim benefit payments are distributed properly and includes such assistance as claims intake, TPN issues, document handling and maintenance of electronic folders and processes, including procurement.

To be successful as a Claim Technician / Administration Support, candidates should be professional, polite, and attentive while also being accurate. The Claim Technician/ Administration Support should always be prepared and responsive, willing to meet each challenge directly. This position must be comfortable with computers, general office tasks, and excel at both verbal and written communication. Most importantly, this position should have a genuine desire to meet the needs of others.

Essential Functions:

1.      Adjudication of all claim types such as physician, hospital, residential, and ancillary claims.

2.      Monitoring claims aging to ensure timely resolution of all pended claims.

3.      Maintains acceptable levels of productivity and quality control.

4.      Awareness around fraud detection and aberrant provider billing practice patterns.

5.      Perform adjustment on incorrectly paid claims.

6.      Offer suggestions for system enhancement and improvements to the claim workflow process.

7.      Assist team members over special projects.

8.      Assist team members as needed and appropriate with general office tasks, including mail.

9.      Maintain polite and professional communication via phone, e-mail, and mail.

10.  Handle sensitive information in confidential matters.

11.  Perform other administrative duties (supplies, scanning, document destruction, etc.).

12.  Anticipate the needs of others to ensure their seamless and positive experience.

Experience, Skills, and Qualifications:

1.      Some college preferred.

2.      AAPC or AHIMA coding/billing certification preferred.

3.      3-5 years of healthcare claims processing and/or billing/coding experience.

4.      Knowledge of ICD-10, CPT and HCPC Coding.

5.      Knowledge of healthcare claims processing and provider contracts.

6.      Excellent time management skills and ability to multi-task and prioritize work.

7.      Ability to assist with special projects.

8.      Accurate and sound administrative and planning skills.

9.      Ability to operate a computer and general office equipment.

10.  Proficiency with Office Suite, Excel, and Word.

11.  Strong organizational skills including attention to detail and multi-tasking skills.

12.  Maintain strict confidentiality of policyholder, Association, and other sensitive information.

This job description does not include all the responsibilities of the position.