• Claims Associate

    Job Locations US-IL-Aurora
    Posted Date 2 weeks ago(11/30/2018 3:53 PM)
    # of Openings
  • Overview



    Looking for a way to influence the health and healthcare of many?


    If so, we’d love to hear from you! Our mission-driven organization is focused on theTriple Aim - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans.


    UNITE HERE HEALTH serves 100,000+ workers and 220,000 covered lives in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!



    Key Attributes:


    • Integrity – Must be trustworthy and principled when faced with complex situations
    • Ability to build positive work relationships – Mutual trust and respect will be essential to the collaborative relationships required
    • Communication – Ability to generate concise, compelling, objective and data-driven reports
    • Teamwork – Working well with others is required in the Fund’s collaborative environment
    • Diversity – Must be capable of working in a culturally diverse environment
    • Continuous Learning – Must be open to learning and skill development.  As the Fund’s needs evolve, must be proactive about developing new areas of expertise
    • Lives our values – Must be a role model for the Fund’s BETTER Culture and Mission (Better, Engage, Teamwork, Trust, Empower, Respect)


    This position is responsible for identifying and selecting medical providers; validating the receipt of all necessary supporting documentation; processing selected claim types in the claims processing system. The Claims Associate will key Health Insurance Claim Forms (HCFA), Uniform Bill 04 (UB), Superbills, vision, and dental claims. This Claims Associate will reject documents received for individuals who are not Fund participants. The above must be accomplished while achieving established production, procedural and quality standards.



    Essential Job Functions:


    • Screens claims for completeness to insure all required information is received
    • Determines the appropriate form type to be keyed based upon the claim received
    • Adjudicates pre-processing claims according to established productivity and quality goals
    • Utilizes the claim adjudication system and the eligibility system to update patient and provider information and route claims to the appropriate personnel for finalization
    • Determines the need for additional information or documentation from participants, providers or other insurance carriers
    • Prepares incoming hard copy documents and routes them to the appropriate processing queues
    • Assists with daily incoming and returned mail including opening, sorting, scanning & uploading images
    • Meetss or exceeds established productivity and quality objectives
    • Monitors inventory aging reports to insure claims are processed within time requirements. Process claims on a first in, first out basis regardless of complexity or difficulty
    • Performs other duties as assigned within the scope of responsibilities and requirements of the job
    • Performs Essential Job Functions and Duties with or without reasonable accommodation


    • High School Diploma or GED
    • 2 ~ 3 years of related experience minimum
    • Minimum of 1 year of healthcare or medical terminology experience preferred
    • Proficiency in medical terminology, ICD 10 and CPT coding, and experience or exposure to health claim processing is required
    • Experience with working an automated claim processing system is preferable
    • Prior experience in an office production environment with quality goals especially related to healthcare benefits administration is preferred
    • Prior experience with eligibility verification, coordination of benefits, medical provider selection, medical coding and subrogation is preferred



    Skills and Abilities:

    • Intermediate level Microsoft Office skills (PowerPoint, Word, Outlook)
    • Intermediate level Microsoft Excel skills
    • Manage competing deadlines and multiple projects in a fast-paced environment
    • Attention to detail, time management, organizational and data entry skills
    • Excellent written and oral communication skills

    • Strong interpersonal skills
    • Ability to work in a goal oriented team structure is essential
    • 10 ~ 15% travel


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