Offer summary

Qualifications:

High school diploma or equivalent required., At least 2 years of claims processing experience., Knowledge of ICD10, CPT codes, and HIPAA guidelines., Proficiency in medical terminology and computer applications..

Key responsibilities:

Evaluate and process pending claims accurately and timely.

Review and adjudicate claims, including research and reprocessing as needed.

Maintain claims data and ensure adherence to procedural and financial standards.

Communicate with members and providers regarding claim status and inquiries.

Job description

Pan-American Life Insurance Group (PALIG) is seeking a Business Associate 2 to join the U.S. Benefits, Claims department. The Business Associate 2 Claims will perform all the duties necessary to ensure group members and providers receive proper payment of policy benefits in a timely manner, while providing excellent customer service. Duties are to include, but are not limited to:

Receiving pending claims for evaluation and processing
Entering and/or reviewing claims data in the claims administration system and adjudicating claims
Processing claims in accordance with Pan-American Life Insurance Group's company strategy and mandated requirements
Accurately coding explanation of benefits
Maintaining claims and task procedural, financial, and timing standards
Completing special projects as needed

Incumbents are to exercise accuracy, attention to detail, adherence to desk level procedures, and excellence at all times in responding to internal/external customers, regardless of the issue, to meet customer demands. Professionalism, self-directed manner, and continuous process improvement are required to ensure and promote customer satisfaction and retention.

The Business Associate 2 Claims will be responsible for the pending claims inventory. Production rates and procedural and financial standards will be higher than a Business Associate 1 Claims. Employee must have maintained the required procedural and financial QC scores for a minimum of 6 months before advancing to this role outside of special circumstances.

ESSENTIAL FUNCTIONS:

Process Claims

Adjudicate pending claims
Review and pend claims requiring additional research
Process claims received and review, research, and reprocess, if applicable, claims from provider and member inquiries or appeals
Pricing claims
Adjudication of adjustments

Workbench Tasks

Create workbench tasks, when needed, for additional claims research
Ensure workbench tasks are accurately and timely documented

Miscellaneous Tasks

Miscellaneous tasks such as updating letters and correspondence and communications with Member Services Representatives and other internal and external customers regarding claim status

KEY EXPERIENCE & REQUIREMENTS:

High school diploma or equivalent
2 years of claims processing experience
Working knowledge of ICD10, CPT codes, and HIPAA guidelines
Working knowledge of medical terminology
Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Ability to keep all company sensitive documents secure
Must live in a location that can receive high-speed internet connection or leverage an existing high-speed internet service
Ability to work an 8-hour shift
Ability to navigate within multiple programs and learn new and complex computer system applications

KNOWLEDGE, SKILLS & ABILITIES:

Adaptability - Proficient
Analytical Skills - Proficient
Attention to Detail - Proficient
Collaboration – Proficient
Computer Applications - Proficient
Multi-tasking Ability - Proficient
Organization/Planning - Proficient
Reading/Writing - Proficient
Standard Keyboard and 10-Key Pad - Proficient
Work Ethic - Proficient
Works Well Under Pressure - Proficient

Pan-American Life Insurance Group Offers:

Comprehensive Compensation Packages (base & bonus)
A Comprehensive Benefits Package: Medical, Dental, 401K, Paid Time Off, and Tuition Reimbursement (etc.) are some examples. New hires are eligible for medical and dental coverage on the first of the month following 30 days of service.
Hybrid Work Opportunities

Who We Are:

Pan-American Life Insurance Group (PALIG) serves the life, accident, and health insurance needs of individuals and businesses in 49 U.S. states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands through its U.S. based member companies - Pan-American Life Insurance Company and Pan-American Assurance Company.

At Pan-American Life, our employees are our greatest asset. We are grateful for the collaborative efforts of our employees and partners, and for the confidence of the policyholders whose life and health we protect. It is through this long-standing commitment that Pan-American Life continues to succeed.

Pan-American Life is an Equal Opportunity Employer/Drug Free Workplace.

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