The Claims Processor is responsible for the timely and accurate processing of commercial claim inventory as assigned by the Claims Processing Supervisor. Using basic analytical and problem solving skills, the Claims Processor is expected to fully examine and resolve all problem codes initially assigned to each claim.
EDUCATION: Associates degree or equivalent business experience in a claims/customer service healthcare environment preferred.
EXPERIENCE: 12-18 months experience in a Tufts Health Plan claims /customer service position or similar claims processing experience required
SKILL REQUIREMENTS: Experience with Tufts Health Plan’s internal applications, such as TAHPMaster, Macess, Infolink, (CMT) preferred. Understanding of managed care concepts and a strong understanding of CPT, ICD-9 (ICD-10), HCPCS coding guidelines and CMS1500 & UB04 billing forms preferred. Position requires basic problem solving and analytical skills with the ability to multi-task. Must be able to work independently and as a part of a team. Ability to effectively communicate to partner departments. Working knowledge of Microsoft Office applications and internet navigation is preferred.
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: Overtime may be required during peak volume periods as requested by management. Requires ability to use personal computer, sitting for extended periods of time.
CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.
Tufts Health Plan - 17 months ago