SUMMARY OF POSITION:
The Carisk Outcomes Claims Representative is responsible for processing professional, and facility claims. (CMS1500/UB04) This includes submitting bills for bill review, adjudicating claims, and finalizing payment. The Claims Representative will work closely with the Configuration team and Data team to ensure all provider payments are timely and accurate.
DUTIES AND RESPONSIBILITIES:
- Process assigned pended claims daily
- Adjudicate routine and complex professional and facility claims according to established policies and guidelines.
- Monitor assigned queues in the bill review system
- Adjudicate claims in payment system based on information from the EOR (Explanation of Review
- Prepare claims for final check run and provider payment
- Respond to provider inquiries including claim status, and payment information
- Work with teams inside and outside the department, as needed delivering excellent service.
- Meet or exceed established productivity and quality goals.
- Two years of experience in a Production Environment
- High school diploma/GED or higher
- Strong customer service skills
- Experience working with all levels of employees and stakeholders
- Demonstrated communication skills both oral and written
- Ability to multi-task and prioritize
- Effective team player
- Proficient in Microsoft office (Word, Excel, PowerPoint)
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.