have a complete understanding of insurance claims and coverage. This person will communicate with all TPA Departments, Accounting, and auditors, as well as possibly interacting with groups, claimants, outside carriers, and agents. To perform the job successfully, the employee must be able to perform each essential duty satisfactorily.
The requirements listed here are representative of the knowledge, skill, and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Performs all check related functions (Runs, refunds, voids). Sends EOB and check files to third party for payment. Reports Check Run Totals to Accounting.
Maintains monthly record of claims paid for account and auditing purposes. Processes claims paid reports to the TPA, Marketing, Eligibility, Accounting, and Auditors as requested.
Ensures new group benefits are set up correctly and sets benefits in CHS. Ensures group renewals are set up correctly and updates benefits in CHS. Compiles data for month-end and annual financial and compliance reporting. Reviews returned checks and enters address corrections into the administrative system(s). Handles ECHO voids/reissue of payments and ECHO updates. Utilizes MWG-Administrators Policy Administration System and Claims Management Software to verify eligibility. Inputs data into MWG-Administrators
Claims Management Software. Performs other duties as assigned by the Department Manager.
EXPERIENCE AND EDUCATION REQUIREMENTS: High School Diploma or GED is required; Associates or bachelor's degree is preferred. Must have previous experience with data reporting and utilization of spreadsheets. Insurance administration or insurance support experience is preferred. Must have general computer skills and be knowledgeable in MS Outlook, Windows, Excel, and Word. Must have basic data entry skills and above average mathematical skills. Must be able to learn and be proficient with the software used in the TPA Departments. Must possess strong time management, organizational, problem solving, and customer service skills.
Must work well under pressure with multiple priorities and meet deadlines while maintaining a strong attention to detail. WORKING ENVIRONMENT: Must be able to perform in a very high paced environment while multi-tasking or handling interruptions. Must have the ability to work independently while practicing effective time management skills. Must be able to prioritize projects, work multiple projects simultaneously, and meet project deadlines in an organized manner. Must possess excellent problem-solving skills and have keen attention to details.
Strong written and verbal communication, interpersonal, and relationship building skills are required. Must be able to handle stressful situations appropriately. Must maintain confidentiality and privacy in every aspect of the job. JOB ESSENTIAL REQUIREMENTS: The following are job functions that an employee must be capable of performing with or without reasonable accommodation. Must be able to read, write, and speak English; Spanish is a plus. Must be able to work as scheduled. Must possess sight and hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of the position as stated above can be fully met.
Must be able to bend, stretch, reach, and sit or stand at a desk during 85% of the workday. Must be able to lift, stoop, and carry small equipment items and supplies, possibly weighing up to 20lbs. Morgan White Group will reasonably accommodate qualified individuals with a disability so that they can perform the essential functions of a job, unless doing so causes a direct threat to these individuals or others in the workplace and the threat cannot be eliminated by reasonable accommodation or if the accommodation creates an undue hardship to Morgan White Group.
MWG is an Equal Opportunity Employer, committed to the principles of the EEOC. All employment decisions are based upon each person's qualifications, abilities, and performance. Our company works to provide an environment where human dignity prevails and all employees and applicants for employment receive equal consideration and fair treatment, without regard to race, color, religion, age, interaction, national origin, disability status, genetics, protected veteran status, interactionual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
