Insurance Healthcare Claims Processor Representative
Hewlett Packard Enterprise – Enterprise Services (HPE ES) is a leading global technology services provider delivering out sourcing services and business solutions to clients around the world. HPE ES founded the information technology outsourcing industry nearly a half-century ago and today delivers one of the industry’s broadest portfolios of information technology, applications and business process outsourcing services available on the market today.
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.
- Review Health Claims that have been paid and determine if they need to adjusted for correction.
- Completes complex tasks related to Healthcare Claims and understand internal processes related to the plan and policies.
- Must be able to multi-task, have a level of independence to grasp the knowledge and overall process.
- Will be assigned multiple assignments to be worked and completed simultaneously as directed by leadership.
- Identifies, prioritizes and resolves most questions and issues independently.
- Complies with contract requirements, business unit rules and related industry and legal regulations.
- Escalate more complex issues or address questions appropriately.
Education and Experience:
- High School Diploma or equivalent; may hold 2 year post-high school Degree or Bachelor’s degree.
- Must have 2-4 years of working experience in the Healthcare Industry.
Knowledge and Skills:
- Office administrative experience and skills.
- Ability to follow written policies, procedures and guidelines, and give feedback to leadership.
- Intermediate-level knowledge of operating systems.
- Self-motivated with good time management and organizational skills.
- Ability to read and interpret basic to moderately complex documents such as operating and maintenance instructions, procedure manuals, and government/healthcare guidelines.
- Excellent written and verbal communication skills and customer service skills, including professional telephone skills.
- ICD-9 and ICD-10 experience is required.
- CPT knowledge is also required.
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