Technical Claims Operations Sr
Tufts Health Plan - Watertown, MA
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- Company
- Tufts Health Plan Tufts Health Plan
- Location
Watertown, MA, US
- Job Type
- Regular
- Job Classification
- Full Time
- Experience
- not provided
- Education
- not provided
- Company Ref #
- 27262726
- AJE Ref #
- 555606662
- [+] More
Job Description
The primary responsibility of the Technical Senior is to research, adjust and resolve complicated claim issues. These issues include but may not be limited to the following: Confidential Claim Processing; Pre-existing processes; Deductible credit processing; Reinsurance; Aim Recovery Process; Coordination of Subrogation Process; Member pending processing.
EDUCATION: (Minimum educations & certifications required)
Requires background in claims processing environment.
EXPERIENCE: (Years of experience)
Experience with various internal systems such as: TAHPMASTER, MACESS, and FOLIO, preferred. Requires a strong understanding of CPT, ICD-9 and HCPCS coding guidelines.
SKILL REQUIREMENTS: (Include interpersonal skills)
Requires excellent problem solving and analytical skills. Must demonstrate a comprehensive knowledge of Tufts HP policies and procedures in relation to claim adjudication. Demonstrate proficiency in both processing and adjustment of complex claim issues. Must be tenacious problem solver with initiative and also possess an ability to prioritize tasks and follow through to completion.
If interested, please apply online at http://track.tmpservice.com/ApplyClick.aspx?id=1371757-1867-7649
