Sr Insurance Specialist Description
Affiliated Computer Services, Inc. (ACS) is expertise in action™. We are a FORTUNE 500 company with 65,000 employees worldwide supporting client operations reaching more than 100 countries. We provide business process outsourcing and information technology solutions to world-class commercial and government clients. Our employees operate with integrity, and are flexible, reliable and responsive.
If you meet the requirements of this position and want to work for a world-class company with a great marketplace reputation, apply today.
SCHEDULE:
Core business hours are Monday through Friday from 8:00 AM to 5:00 PM. Provides administrative support to the claim processing function. May perform one or more of the following:
MAJOR POSITION RESPONSIBILITIES:
Provides administrative support to the claim processing function. May perform one or more of the following:
- Processes complex claims for all physician, facility and specialty claims in accordance with company policies and procedures in a timely manner that meets or exceeds productivity and quality goals.
- Researches unpaid and denied claims to determine course of action.
- Researches customer information in response to difficult inquiries including, but not limited to, authorizations, payments, denials, coordination of benefits, and eligibility.
- Assesses, investigates and resolves difficult issues to achieve customer satisfaction.
- Interfaces with customer by telephone, correspondence and/or in person to answer inquiries and resolve concerns.
- Comply with HIPAA legislation and company policy.
- All other duties as assigned.
REQUIRED (minimum):
- Requires a high school diploma or its equivalent and/or vocational training.
- Experience in building/maintaining customer relationships
- Works on assignments requiring considerable judgment and initiative. Understands implications of work and makes recommendations for solutions.
- Determines methods and procedures on new assignments. May be informal team leader.
- Typically requires a minimum of 8 years of related experience.
- Ability to maintain production levels and quality goals.
- Extensive customer service and/or team experience. Advanced knowledge of health care products under both fully insured and self-funded arrangements, medical terminology, diagnosis and procedure coding, and coordination of benefits.
- Ability to establish and maintain effective working relationships.
- Excellent organizational, interpersonal, and communication skills.
- Strong analytical and problem solving skills.
- Ability to train employees on all products and processes.
- As a skilled incumbent, completes tasks in a resourceful and effective manner.
PERFERRED:
- Detailed understanding of Medicaid policies and procedures at both Federal and state levels
- Demonstrated proficiency in adapting/tailoring best practices/processes to business needs.
ACS is an Equal Opportunity Employer and does not Discriminate against any applicant on the basis of race, color, religion/creed, national origin, gender, or sex, marital status, age, disability, use of a guide dog or service animal, sexual orientation, military/veteran status, or any other status protected by Federal or State law or local ordinance. People with disabilities who need a reasonable accommodation to apply or compete for employment with ACS may request such accommodations by calling 866-419-2226 .
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