Medical Claims Representative

at  Robert Half

Job Summary
The Claims Liaison (CL) has responsibility for the oversight of all aspects of operational support for the Disability Management Services disability claim review process, including any administrative and/or clerical tasks as further described herein. This position also provides support to the Disability Nurse Case Managers (DNCM) and assists with projects, as deemed necessary.
Job Description

Role and Responsibilities

• Initiates claims from the client to determine whether all required documentation was received.
• Receive electronic disability claim notifications and assigns to appropriate Supervisor and/or DNCMs, as per client-specific protocol.
• Outreach to members regarding the disability claim review process per approved client-specific telephonic scripts.
• Track scheduled incoming claims documents for timeliness, as applicable (e.g. medical records; initial claim documents including disability applications and/or attending physician statements; medical release forms; other required claim documents).
• Prepare and mail claim correspondence documents to members, as applicable, within established timeframes (e.g. Disability Application Material; Request for Return Call letter; Additional Information Needed letter; Non-Compliance letter, etc.).
• Create and/or modify documents, such as reports, memos, and letters, using word processing, spreadsheet, database, and/or other presentation software (i.e. Microsoft Office, Excel, Microsoft CRM, Oracle, or other programs).
• Answer incoming telephone calls regarding claims as transferred from Front Desk; forward to appropriate staff member, as needed.
• Creation of Recommendation Summaries, including compiling and verifying all accompanying claim documents to be sent to the client upon completion of the disability claim review process.
• Open, sort, and distribute appropriate incoming correspondence, including U.S. mail, faxes, email and/or UPS/FedEx, as needed.
• Assist with tracking and trending department turnaround times for reporting purposes.
• Maintain confidentiality in all aspects of client, staff, and organizational information.
• Perform general clerical duties to include, but are not limited to: copying, scanning, faxing, mail merging, mailing, and filing, as deemed necessary.
• Upload documents into Spring CM and SharePoint, as applicable.
• Other duties, as deemed appropriate.

Required Qualifications and Education

• High school diploma or equivalent
• At least two (2) years of experience in general office responsibilities and procedures
• Detail-oriented
• Ability to work autonomously as well as within a team structure
• Proficient in MS Word and Excel.
• Good communication skills
• Good telephonic speaking skills
• Ability to multi-task
• Good written and verbal skills
• Ability to operate standard office equipment, including but not limited to: computers, telephone systems, copiers, scanners, facsimile machines
• Ability to follow oral and written instructions

Preferred Skills and Additional Experience
None
ADA Requirements

• Initiates claims from the client to determine whether all required documentation was received.
• Receive electronic disability claim notifications and assigns to appropriate Supervisor and/or DNCMs, as per client-specific protocol.
• Outreach to members regarding the disability claim review process per approved client-specific telephonic scripts.
• Track scheduled incoming claims documents for timeliness, as applicable (e.g. medical records; initial claim documents including disability applications and/or attending physician statements; medical release forms; other required claim documents).
• Prepare and mail claim correspondence documents to members, as applicable, within established timeframes (e.g. Disability Application Material; Request for Return Call letter; Additional Information Needed letter; Non-Compliance letter, etc.).
• Create and/or modify documents, such as reports, memos, and letters, using word processing, spreadsheet, database, and/or other presentation software (i.e. Microsoft Office, Excel, Microsoft CRM, Oracle, or other programs).
• Answer incoming telephone calls regarding claims as transferred from Front Desk; forward to appropriate staff member, as needed.
• Creation of Recommendation Summaries, including compiling and verifying all accompanying claim documents to be sent to the client upon completion of the disability claim review process.
• Open, sort, and distribute appropriate incoming correspondence, including U.S. mail, faxes, email and/or UPS/FedEx, as needed.
• Assist with tracking and trending department turnaround times for reporting purposes.
• Maintain confidentiality in all aspects of client, staff, and organizational information.
• Perform general clerical duties to include, but are not limited to: copying, scanning, faxing, mail merging, mailing, and filing, as deemed necessary.
• Upload documents into Spring CM and SharePoint, as applicable.
• Other duties, as deemed appropriate