Claims Specialist I

Claims Department in Life & Health Division

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As of April 9, 2024

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Responsibilities which include but not limited to:

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• Conduct computer entries of confidential medical, dental, vision & pharmacy claims of members

• Process deductibles, on-island and CNMI hospital claims, editor claims, reimbursements and reconciliations

• Create and generate letters for members and providers

• Attend and participate in provider meetings

• Responsible for fax back maintenance

• Transmit claims over $10,000 and perform small claims audit

• Manage Third Party/Subrogation processing for on island and CNMI hospital claims

• Provide guidance to the Philippine Support Group in handling claims

• Conduct department training to less experienced staff members

• Serve as a backup in customer service

• Any other job related duties as assigned by supervisor

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Position Requirements

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• High school diploma or equivalent required

• A minimum of two years experience in insurance claims processing preferred

• Prior experience in using claims processing software, i.e. WLT, is preferred

• Experience with Microsoft Office (ex: Outlook Express, Microsoft Word/Excel)

• Experience with operating Xerox machine (ex: Copy, Fax and Scan)

• Must have excellent communication skills in verbal and written form

• Able to handle multiple assignments under high pressure

• Able to work independently and exercise good judgment

• Highly organized and dedicated with a positive attitude

• Team Player

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