NO EXPERIENCE NECESSARY- WE WILL TRAIN
Do you want a career where you can make a difference? Allegiance
is a growing company with hometown values that is looking for
dynamic candidates to join the team! A positive, team-oriented
environment is provided with opportunities for advancement.
Allegiance offers full-time positions with evenings, weekends,
and holidays off and a multi-faceted benefits package.
We pride ourselves in having a reputation for top-notch customer
service. Make a difference. Start your career with Allegiance
The Claims Examiner is responsible for the accurate and timely
processing of medical, dental, vision and prescription drug claims.
The incumbent is expected to provide courteous and prompt responses
to customer inquiries.
The incumbent is expected to communicate professionally with
peers, supervisors, subordinates, vendors, customers, and the
public, and to be respectful and courteous in the conduct of this
ESSENTIAL JOB FUNCTIONS:
Essential job functions include the following. Other functions
may be assigned as business conditions change.
Verifies the accuracy and receipt of all required documentation
for each claim submitted.
Collaborates with providers, plan participants, other claims
payers, or any other party necessary to obtain information
necessary to accurately process a claim.
Analyzes information necessary for processing. This includes,
but is not limited to, general participant and provider
information, managed care affiliation, diagnosis codes, dates,
place, type of service, procedure codes, and charges.
Assures that the system processes the claim correctly and
determines payment according to the plan as written.
Word-processes correspondence to plan participants and providers
in reference to pre-determinations and in response to basic benefit
Answers telephone calls from plan participants, group contacts,
and customer service representatives pertaining to benefits and
Resolves problematic claims with the assistance of the Team
Leader, Claims Manager and/or the Director of Claims.
Assigns critically ill patients to large case management.
Assists the case manager with direct negotiation and the efficient
use of benefits.
Assists other examiners as needed due to workload requirements,
including assigned back-up when examiners are absent.
Aids the Team Leader and/or the Claims Manager in the resolution
of claim appeals and disputes by providing documentation for
Researches, calculates and requests refunds when necessary.
Contributes to the daily workflow with regular and punctual
Thoroughly researches and completes renewal reports in a timely
manner in consultation with the Marketing Department.
Process eligible claims on groups before the end of their
stoploss contract renewal period.
NON-ESSENTIAL JOB FUNCTIONS:
Performs related or other assigned duties as required or
Assists the Legal Department with subrogation claims as
Attends various group meetings as required.
Assists with audits as needed.
Assists with plan benefit set-up and changes as needed.
PHYSICAL WORKING CONDITIONS:
Physical requirements are representative of those that must be
met to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions.
Sitting 80% Reaching Some
Standing 10% Manual Dexterity High
Walking 10% Telephone Yes
Kneeling Some Computer Screen High (visual acuity corrected to
Bending Some Lifting up to 30 pounds
To perform this job successfully, an individual must be able to
perform each essential duty satisfactorily. The requirements listed
below are representative of the knowledge, skill, and/or ability
required. Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential
Minimum Education: High school graduation or GED required.
College degree and/or training in medical terminology
Certification(s) Required: LOMA/ICA and HIAA coursework and
Minimum Experience: Experience in claims processing, medical
billing, insurance, or health services preferred. Familiarity with
group health benefits preferred.
Other Qualifications: Excellent oral and written communication
PC skills, including Windows and Word. Ability to learn all
functions of the claims processing software as is necessary for
claims processing and adjudication. Must be able to adapt to
software changes as they occur.
Typing ability of 45 wpm net.
Knowledge of medical terminology and basic health insurance
Excellent listening skills.
Basic mathematical skills.
High level of interpersonal skills to work effectively with
Ability to organize and recall large amounts of detailed
Ability to read, analyze and interpret benefit summary plan
descriptions, insurance documents, plan benefits, and regulations
and make appropriate applications to specific situations.
Ability to meet productivity standards with 99% financial
accuracy and 95% procedural accuracy.
Thorough knowledge of claims processing procedures and
Ability to project a professional image and positive attitude in
any work environment.
Ability to comply with privacy and confidentiality
Ability to be flexible, work under pressure and meet
Ability to analyze and solve problems with professionalism and
patience, and to exercise good judgment when making decisions.
Ability to operate typical office equipment.
Working knowledge of general office procedures.
The above statements are intended to describe the general nature
and level of work being performed. They are not intended to be
construed as an exhaustive list of all responsibilities, duties,
and skills required of personnel as classified.
- Allegiance Benefit Plan Management, INC is an Equal Opportunity