Claims Intake Specialist

Department: Data Entry
Direct Report: Rick Gunzel, IT Director
Location: Roanoke, VA.

POSITION SUMMARY

The Claims In-take Specialist is responsible for monitoring all client secured sites for incoming claims and the process of entering individual cases into Medliminal proprietary software system.  The Claims In-take Specialist will submit accepted claims to the transcription team and verify accuracy on the returned transcribed claim.  The Claims In-take Specialist will also perform preliminary set-up steps for Claims Analyst.

DUTIES AND RESPONSIBILITIES

Specific Duties Include:

  • Monitor and Verify Documents for Incoming Claims
    • Monitor computer for incoming claim auto notification
    • Conduct spot check of client secured site for missed auto notifications
    • Create CID for claim
    • Enter basic claim information for analyst
    • Verify all required claims submission documents are present and legible
    • Complete claim pending form for missing documents
    • Obtain pending form sign-off from Director of Consumer Division
    • Submit form to Claims Control Specialist
    • Request itemized statements (upon client request)
    • Other B2B claims issues as needed
  • Manage Transcriptionist 
    • Transfer claim documents to transcription team
    • Notify Claims Reimbursement Specialist of CID number for post-pay claims, workers comp. claims, and pilot test claims
    • Compare transcribed data against original for discrepancies
    • Correct any discrepancies with transcribed bills
    • Other B2B claims issues as needed
  • Perform Preliminary Set-Up Process
    • Perform initial set-up of individual claims and CID in system
    • Transfer file to claim available for review

MINIMUM STANDARD REQUIREMENTS, SKILLS, AND ABILITIES

  • Must be computer savvy
  • Two years of experience working in excel and access programs
  • Fast typing skills with accuracy
  • Great attention to details
  • Ability to communicate with others and follow procedures

INTENT AND FUNCTION OF JOB DESCRIPTIONS

Job descriptions assist organizations in ensuring that the hiring process is fairly administered and that qualified employees are selected. They are also essential to an effective appraisal system and related promotion, transfer, layoff, and termination decisions. Well-constructed job descriptions are an integral part of any effective compensation system.

All descriptions have been reviewed to ensure that only essential functions and basic duties have been included. Peripheral tasks, only incidentally related to each position, have been excluded. Requirements, skills, and abilities included have been determined to be the minimal standards required to successfully perform the positions. In no instance, however, should the duties, responsibilities, and requirements delineated be interpreted as all-inclusive. Management reserves the right to modify, add or remove essential functions as business needs warrant. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

In accordance with the Americans with Disabilities Act, it is possible that requirements may be modified to reasonably accommodate disabled individuals. However, no accommodations will be made which may pose serious health or safety risks to the employee or others or which impose undue hardships on the organization.