Data Entry Clerk

Job Description: The Insurance/Healthcare job family contains positions associated with providing consultancy utilizing knowledge and expertise on insurance and healthcare. Develops and implements general insurance and health policies in accordance with state and federal laws. Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions. Responds to provider appeals and meets with providers to resolve problems/issues. Provides directions for utilization review. Approves any remedial or recoupment actions associated with escalated claims. Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues related to insurance and healthcare programs.

Responsibilities:

  • Participates productively as a key member of the team, possibly in a team lead role.
  • Completes complex tasks and defined processes. Suggests creative solutions.
  • Multiple complex assignments are worked and completed simultaneously with minimal input from leadership.
  • Identifies, prioritizes and resolves most questions and issues independently. Answers questions of peers. Escalates more complex questions or issues appropriately.
  • Complies with contract requirements, business rules and related industry and legal regulations

Education and Experience:

  • High School Diploma or equivalent; may hold 2 year post-high school Degree; may hold Bachelor’s degree.
  • Typically, 1-2 years of working experience in related fields

Knowledge and Skills:

  • Strong office experience and skills. Strong data entry experience.
  • Intermediate to Senior level knowledge of operating systems, and of software skills.
  • Ability to read and interpret moderately complex documents such as operating and maintenance instructions, and procedure manuals.
  • Self-motivated with strong time management and organizational skills.
  • Excellent written and verbal communication skills and customer service skills, including professional telephone skills.

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