Claims Specialist

About the role

The Claims Specialist (PS2) is responsible for processing and analyzing claims using prescribed processes based on existing policy contracts and guidelines. The role involves verifying claims details, preparing transmittals for payment, approving payments within authority limits, and reconciling claims with providers. The position also includes conducting user acceptance testing (UAT) of system enhancements, providing customer service regarding claims status and payment inquiries, and maintaining effective relationships with assigned accounts through regular coordination and timely resolution of claims-related concerns.

Key responsibilities

• Check availability and accuracy of claims details in MAS and make necessary corrections
• Verify unlisted claims in MAS with biller and Alarm Center
• Process and analyze claims using prescribed processes and based on existing policy contract and guidelines
• Prepare transmittal of claims for payment
• Approve payment for claims within authority limit and recommend approval of claims payment beyond authority limit
• Reconcile claims with providers and accounts
• Conduct UAT of system enhancements and provide analysis and findings
• Answer inquiries via email or phone regarding status of claims or overdue payments within set turn-around time
• Document medical claims disputes or complaints and resolve or escalate within TAT
• Reconcile statement of account (SOA) sent by providers and coordinate with concerned departments on reconciliation items

About you

• College graduate with a degree in any medical or business-related discipline
• At least 1 year experience in medical or life claims processing
• Preferably passed Life Office Management Association (LOMA) courses