Claim Specialist

Maintaining a positive, empathetic, and professional attitude toward customers at all times  Responding promptly to customer inquiries  Communicating with customers through various channels  Acknowledging and resolving customer complaints  Knowing our products inside and out so that I can answer questions  Quote claim status and processing claims for adjustment  Quote benefits and coverage of the member  Keeping records of customer interactions, comments, and complaints  Communicating and coordinating with colleagues as necessary  Ensure customer satisfaction and provide professional customer support  Outbound calls to provider/billing office for dispute of the bills/claims  Follow-up calls to the member If necessary  Anti-fraud/HIPAA verification  Doing outbound calls to provider for the claims/bills dispute  Provides assistance to members having a problem with their Health Savings debit card  Checking ICD-codes If its under preventive or covered by Health Insurance

Handling Patient Inquiries & Correspondence.

Providing policy holder's eligibility and benefits to agents who is HIPAA validated.

● Arranging records of patients ● Attending phone calls in the reception ● Reporting daily census ● Sending patient's file to designated clinic and department ● Collecting file after clinic hour ● Tracks patients file/s just in case it’s being asked by an authorized personnel ● Navigating the patient files status by using OASIS system (EMR) ● Typing some letter for hospital purposes or personal purposes ● To insert doctor’s report into the files ● To scan some papers of the patients and save it to OASIS system (EMR)

Private healthcare insurance with experience of claim related concern, provide eligibility, and benefits to caller.

-Claim mapping -Adjusting claim based from the benefits -Approval of claim or denial -Checking of prior authorization -Adding copay, coinsurance, and sequestration -proper documentation -Ensure accuracy of every claims -Collaborating with team -

HIPAA validation before providing details to policy holder, agent, broker, provider, and others.

Using ICD codes to check If claim is in-network with the health insurance.