Claims Processor

Under the supervision of Claims Manager, performs accurately all functions related to dental claims processing. Follows processing rules, guidelines, and policies. Meets department productivity, quality, and accountability standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Key Responsibilities

• Electronically images hardcopy claims batch as OCR, Non-OCR, and x-ray attachments.  Batch image paper attachments, POAs and adjustments, and back-end imaging of claims documentation. Inputs rejected and RFI claims notices.
• Performs all aspects of claims data entry, including verification of required documentations.
• Processes Levels 1, 2 and 3 claims consisting of single, COB-S, Dual, Pre-authorizations and out of state type claims. Reviews all levels of suspended electronic claims including opening and sorting of ECS mails. Processes requests to pay pre-authorizations.

Other Duties and Responsibilities

• Assists the Claims department in adhering to established document policies and procedures.
• Provides back-up support and assistance in Customer Service and other departments as necessary.
• Accomplishes special projects as assigned.
• Determines and follows through with a plan to meet annual goals set up with the supervisor.
• Takes responsibility for relationships with others in the department and company.
• Works as a team player and assists wherever there is a need.
• Maintains a customer advocate attitude, understanding the importance that timely and accurate claims processing has on customer satisfaction.
• Other miscellaneous duties and responsibilities as assigned.

MINIMUM QUALIFICATIONS AND EXPERIENCE

Education

High School Diploma or its equivalent required.

Experience 

Minimum two years of clerical experience, customer service, sales, or any combination of education and experience which would provide the necessary knowledge, skills, and abilities to meet the minimum qualifications to perform the essential functions of this position.

Skills and Knowledge

• Working knowledge of PC applications (i.e., word processing and spreadsheets) highly desirable.
• Requires demonstrated customer service skills and sales ability.
• Ability to maintain focus and attention to detail.
• Ability to handle multiple tasks with some distractions.
• Ability to communicate orally and in writing with all levels of staff, customers and vendors.
• Ability to handle all information in a confidential manner and in compliance with federal and state laws/regulations (i.e., HIPAA, PHI).

Note: The above information in this description has been designed to indicate the general nature and level of work performed by an employee in this classification.  It is not to be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications of employees assigned to this job.  Hawaii Dental Service has the right to add to, revise, or delete information in this description.  Reasonable accommodation will be made to enable qualified individuals with disabilities to perform the essential functions of this position.