Process all new claim pricing inventory in manual mailboxes for dual platform/networks
Pricing identification of errors and management of resolution with provider contracting/maintenance internal teams.
Identifies steps necessary to process a varying complexity of contracts for pricing accuracy
Researches, analyzes and calculates claims in accordance with provider contracts
Works with internal matrix partners to resolve pended claims issues
Utilizes SRS to route work items to matrix partners and external retailer claim administration staff
Follow audit protocols and workflows to ensure quality goals.
Work in NetworX application to correct claims due to matching errors.
Data entry of claims into ENS application for auto-pricing
Manual pricing/handling of TPN claims for retailers and their customers
Manage pended and open claim reports to ensure timely processing.
Special pricing projects as requested by retailers
Partners with matrix organizations to ensure that appropriate action is taken to identify and implement high potential
1 to 2 years experience in claim operation environment, preferably pricing claims.
Knowledge of contracting terms, fee schedules, rates
Accurate keyboarding and data entry skills
System knowledge or application experience in ECS, ENS or NetworX
Analytical, attention to detail and quality oriented.
Strong organizational and time management skills
Strong written communication skills
Knowledge of MS applications with exposure to Access and Excel programs
Problem solving skills
Able to manage multiple tasks and work under pressure in a fast paced environment..
CIGNA - 2 years ago
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With a significant position in the US health insurance market, CIGNA covers some 11.5 million Americans with its various medical plans. The...