What are the responsibilities and job description for the Medical Claims Specialist/Examiner position at Vanguard Temporaries, Inc.?
Serves medical insurance customers by determining insurance coverage; examining and resolving medical claims; documenting actions; maintaining quality customer services; ensuring legal compliance.
Duties:
* Determines covered medical insurance losses by studying provisions of policy or certificate.
* Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims.
* Documents medical claims actions by completing forms, reports, logs, and records.
* Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter.
* Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.
* Maintains quality customer services by following customer service practices; responding to customer inquiries.
* Provides legal support by assembling documentation for settlement action.
* Protects operations by keeping claims information confidential.
* Prepares reports by collecting, analyzing, and summarizing information.
* Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
* Accomplishes organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
Skills/Qualifications:
Claims Adjustment, Financial Software, Documentation Skills, Data Entry Skills, Analyzing Information , Problem Solving, Verbal Communication, Customer Focus, FDA Health Regulations, General Math Skills, Statistical Analysis
About the Company:
Vanguard Temporaries, Inc.
For more than 45 years, Vanguard has provided reliable, hands-on recruiting services to the entertainment, finance, banking, media, advertising industries and more. Founded in New York City in 1970, Vanguard provides staffing services throughout the Tri-State area. As accounting and finance, administrative clerical and freelance creative graphic design recruiters, we understand the importance of working together as a team in all aspects of our business. And we communicate openly with staff, clients, and the people that we place. Why Vanguard? We’re a full-services staffing solutions provider. Knowledgeable staff to update employees and clients on industry changes, legal issues, and company information Around-the-clock availability to answer any questions or address concerns. Tenured internal staff operates like a family. We are honest, we care, we are knowledgeable, and we are good at what we do. All of our management are accessible and hands-on members of the team.
Company Size:
500 to 999 employees
Industry:
Accounting and Auditing Services
Founded:
1970
Salary : $18 - $28