HealthAxis Group is looking for a Claims Specialist to serve our Medicare insurance customers. In this role, you will determine insurance coverage, examine and resolve Medical claims, and ensure legal compliance while delivering quality customer service. We are a company that lives and works with purpose, cares about others, and acts with integrity, putting people first in all we do.

What You'll Do

Process claims in accordance with production, timeliness, and quality standards.
Participate with other health plan departments in the resolution of claims issues across department lines.
Ensure claims are processed in compliance with governmental and accrediting agency regulations.
Ensure the delivery of superior customer service by providing timely and accurate claims payment and responding timely to member and provider inquiries.
Develop strong intradepartmental relationships to ensure clear communication and prompt resolution to issues.
Follow departmental policies and procedures regarding claims adjudication.
Identify and report potential fraudulent claims practices to the appropriate compliance department.
Follow all HIPAA compliance guidelines to ensure protection of member protected health information.
Drive the HealthAxis culture through values and customer service standards.
Be accountable for outstanding customer service to all external and internal contacts.
Develop and maintain positive relationships through effective and timely communication.
Take initiative and action to respond, resolve, and follow up regarding customer service issues with all customers in a timely manner.

What We're Looking For

A high school diploma or general education degree (GED).
A minimum of two years’ experience in a managed care claims processing environment.
Experience with the internal configuration of claim processing systems and the links between contracts, utilization management, and claims processing within these systems.
Understanding of hospital and/or physicians’ contracts to determine payable benefits and knowledge of pricing DRG, APC, and per diem for all Medical claim products.
Excellent oral and written communication skills including good grammar, voice, and diction.
The ability to read and interpret documents and calculate figures and amounts.
Proficiency in MS Office with basic computer and keyboarding skills.
Excellent customer service skills (friendly, courteous, and helpful).