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Healthcare Claims Adjuster

Company: Ascension (System Office)
Location: Sterling Heights
Posted on: May 18, 2018

Job Description:

Healthcare Claims Adjuster Job ID: 248605 Healthcare Claims Adjuster Sterling Heights, Michigan Regular / Day Additional Job Information Title: Healthcare Claims Adjuster City, State: Sterling Heights, MI Location: US Health Holdings/ABS Department: ACO Claims Management 003 Additional Job Details: FT, Days, 37.5 hours weekly, 8:30am-4:43pm M-F About Us Ascension is a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As the largest non-profit health system in the U.S. and the world's largest Catholic health system, Ascension is committed to delivering compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable. In FY2016, Ascension provided more than $1.8 billion in care of persons living in poverty and other community benefit programs. Ascension includes approximately 150,000 associates and 36,000 aligned providers. Ascension's Healthcare Division operates 2,500 sites of care - including 141 hospitals and more than 30 senior living facilities - in 24 states and the District of Columbia, while its Solutions Division provides a variety of services and solutions including physician practice management, venture capital investing, investment management, biomedical engineering, facilities management, clinical care management, information services, risk management, and contracting through Ascension's own group purchasing organization. Job Description Analyzes and processes claims for insurance or self-funded policies. Documentation of Computer system on all correspondence and information related to claims processing. Responsibilities: Analyze and process Medical, Dental, Rx, HRA/HSA claims, correspondence and status inquiries from both providers and members. Request additional information as needed Maintain reference materials with current information Move claims needing additional attention to the correct mailbox for handling Ensure the resolution of claim Issues routed for clarification Competency: To perform the job successfully, an individual should demonstrate the following competencies: Identifies and communicates processing/systems problems promptly Able to communicate clearly both oral and written Attendance/Punctuality - is consistently at work on time Ability to monitor workflow to ensure timely processing Computer literate Qualifications Education: Bachelor's Level Degree Bachelor's level degree or High School diploma (GED) with equivalent combination of education and experience Work Experience: Two years of claims experience Language ability - Ability to read and interpret documents, such as plan documents or procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization. Physical demands - While performing the duties of this job, the employee is regularly required to sit, use hands and fingers, talk and hear. Vision abilities required by this job include close vision. Measurables - Turnaround Correspondence within 24 hours/Claims within 5 business days. Productivity - 20-25 claims per hour, depending on work type for on-site adjusters. 1400 claims per week for full time status for off-site adjusters. 700 claims per week for part-time off-site adjusters. Accuracy Rate - Maintain company standards of 95% procedural and 98% financial accuracy rate of better. Attendance - Meet company attendance policy Equal Employment Opportunity Ascension Health is an EEO/AA employer: M/F/Disabled/Vet. For further information regarding your EEO rights, click on the following link to the "EEO is the Law" poster: Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants. E-Verify Statement Ascension Health participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information. Share: ->

Keywords: Ascension (System Office), Detroit, Healthcare Claims Adjuster, Healthcare, Sterling Heights, Michigan

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