Fort Washington, Pennsylvania
Job ID: #84976
MOUNTAIN, LTD. has an opening for a Claims Specialist in the Fort Washington, PA area.
Since 1979, MOUNTAIN, LTD. has successfully created and supported the most innovative career pathways for job seekers. Our dedicated internal vendor management has a longstanding relationship across diverse industries, ranging from telecom to insurance. In the evolving landscape of employment, MOUNTAIN has relationships with some of the top companies across the nation.
- Analyze routine insurance claims to determine the extent of the insurance carrier's liability and to settle claims in accordance with the plan provisions.
- Sets adequate reserves to ensure proper reporting.
- Compares data on claim form with insurance plan to ascertain completeness and validity of claim.
- Examines claim form and other records to determine insurance coverage.
- Proactively works to resolve claim as expeditiously as possible.
- Reviews and analyze detailed medical records.
- Calculates reimbursement of benefits according to the schedule of coverage.
- Runs various claim reports as directed by the account.
- Approves claims at the appropriately demonstrated assigned authority level. Handles difficult phone calls.
- Composes special correspondence.
- Works on special projects and tasks as assigned.
- Other duties as assigned.
- Claims adjudication experience or relevant Berkely experience.
- Writes clearly, concisely and effectively.
- Communicates verbally effectively and with impact.
- Computer literate.
- Detail oriented.
- Ability to multi-task Manages time effectively.
- Committed to superior customer servicing.
- Ability to work independently, a self- starter.
Thank you for your interest in MOUNTAIN, LTD. For more information please contact firstname.lastname@example.org.