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Claims Associate I


Group Benefit Services (GBS)

Job Description:

Claims Associate I Location Springfield, MO 65804 Industries Insurance / Claims Department Job Type Employee Full Time Education and Experience Level The ideal candidate will possess at least a High School Degree and some college or technical training with at least two (2) years of actual Claims Processing in the Health Insurance Industry. Customer Service experience in the Health Insurance Industry is helpful. Applicable experience may be substituted on a year-to-year basis for the education requirement. Career Level Mid Level Salary Salary range is $12.02 – $13.94 per hour and is commensurate based on experience and education. Job Reference Code CA-091 Job Title Claims Associate I About the Job Job Purpose: The Claims Associate performs claims adjudication and management services for self-funded health plans. The Claims Associate will review and adjudicate medical, dental and vision claims. In addition, the individual chosen for this position will have its own assigned accounts and works directly with its Plan Members to deliver exceptional customer service and assists them with their needs known as “Dedicated Claims Service.” The role of the Claims Associate is to maintain a very high level of accuracy and customer service that enables GBS to be second to none in the industry. Likewise, the individual is expected to keep up with changes in the industry in order to maintain sharpness in their area of expertise. GBS provides opportunity for the right candidate for a long term career path to grow with the company. Duties and Responsibilities:Responsible for accurate and timely adjudication of claims according to guidelines.Analyze, process, research, adjust and adjudicate claims with the use of accurate procedure/revenue and ICD-10 codes, under the correct provider and member benefits, i.e. co-payments, deductibles, etc.Claims processing based upon contractual and/or Our Client agreements, involving the use of established payment methodologies, applicable regulatory legislation, claims processing guidelines and company policies and procedures.Alerts manager or supervisor of issues that impact production and quality, i.e. incorrect database configurations, non-compliant claims, etc. Responds to incoming calls in a timely and courteous manner Provides professional written and verbal Customer Service skills Maintain quality and productivity standards as set by Management Maintaining compliance with PHI and HIPAA requirements Flexibility and ambition to learn new skills in a changing environment Skills, Knowledge, and Abilities (SKAs)/Qualifications: Focus on quality work and job performance Must be able to multi-task, be well organized and detail oriented Provide the best possible customer service to every customer Must be proficient working with database and processing software, excel, word and outlook Must have mathematical, problem solving and analytical skills Must have good written and verbal communication skills Additional Requirement(s) and Information: Applicants will be tested and qualifications will be verified. Open until filled.

Company Description:

Group Benefit Services, Inc. (GBS) is an insurance claim technology organization headquartered in Springfield, Missouri. GBS has a variety of resources to provide a premier quality of employee benefit programs helping to deliver what Plan Sponsors want most, improved savings, optimal quality, and positive member experience. Quality People & Technology, Delivering Best in Class Performance.

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