Claims Specialist (Full Time)

Location: Fargo

 

POSITION OVERVIEW

The Claims Specialist is responsible to properly review and process claims for flexible spending accounts and health reimbursement arrangements as well as disbursement requests for health savings accounts in accordance with Section125 regulations.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Daily claim processing
    • Accurately adjudicate and key all claim types.
    • Determine eligibility by utilizing available resources.
    • Ensure priority of workload is followed and turnaround times are met.
    • Properly adjudicate claim appeals.
    • Troubleshoot software issues accordingly.
  • Assist with other operational functions
    • Coordinate with other departments when appropriate.
    • Assist with projects as assigned.
  • Work with Supervisor and Team Leads to develop new processes and procedures
    • Continuous improvement approach to work.
    • Communicate changes needed for processes.
  • Promote continuous learning and sharing of knowledge
  • Ensure privacy according to HIPAA
  • Work on special projects as assigned
    • Assist Claims Supervisor and Team Leads with special projects.
    • Develop and update procedures as needed.

COMPETENCIES

  • Interact with team members and customers in a warm and friendly way.
  • Must have strong verbal communication skills, ability to read and write effectively. Must have the ability to listen, evaluate and exercise independent judgment. Must be able to maintain confidentiality when using sensitive materials. Build effective working relationships. Treat others with respect.
  • Work in a manner that considers the entire organizational and departmental impact. Demonstrate personal commitment to the principles, values, and ethics of the organization.
  • Is an example to others of appropriate professional behavior.
  • Must have the computer competency necessary to navigate on the computer to provide system issue resolution.
  • Require the manual dexterity to efficiently operate a computer.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES

  • Understanding of Section 125 administrative processes and procedures
  • Understanding of HIPAA and Privacy Regulations
  • Computer proficiency required
  • Strong organizational skills
  • Excellent analytical skills
  • Self-motivated
  • Innovative
  • Meets daily deadlines consistently
  • Must take initiative in jobs performed; seek solutions and answers to problems
  • Flexibility/ adaptability