Position Title: Claims Specialist

Reports To: Claims Manager 

Qualifications: 

• Excellent written and oral communication skills 
• Basic computer skills with exposure to Microsoft Office preferred 
• Ability to organize and handle multiple tasks well 
• Extraordinary attention to detail 
• Good math skills 
• Good time management skills 
• Good customer service skills 

Position Requirements: 

• Complete assigned duties accurately and in a timely manner 
• Repricing error level is expected to be less than or equal to 1.00% 
• Active participation (or facilitation when necessary) in meetings 
• Provide adequate input and feedback 
• Exude problem solving skills when required 
• Maintain and display a positive and team‐oriented attitude 
• Team engagement on a continual basis 
• Continual courteous and professional behavior 
• Comply with all guidelines set forth by ProviDRs Care 
• Maintain a professional phone etiquette 
• Adhere to HIPAA compliance requirements 

Responsibilities: 

• Update eligibility records as assigned 
• Complete assigned claims queues 
• Complete Primary queue assignments within established TAT 
• Complete Secondary queue assignments within established TAT 
• Prepare reports as requested 
• Analyze data/information as requested 
• Work mail as assigned 
• Open / Sort 
• Pull out claims that require special handling instructions 
• Scan 
• Upload Files 
• Prep & Mail out 
• Answer telephone calls according to assigned schedule 
• Provide customer service via telephone, email, facsimile, etc... as needed 
• Complete assignments given by Claims Manager 
• Cross training as assigned by Claims Manager 
• Processing of Clearinghouse and Payer Rejects 
• Perform entry level Quality Assurance as assigned