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Senior Claims Administrator in Indianapolis, IN at Tokio Marine HCC

Date Posted: 1/31/2018

Job Snapshot

Job Description

Tokio Marine HCC – Medical Insurance Services (MIS) Group has an opening for a Senior Claims Administrator in Indianapolis, IN.

Under general direction, audits claims processed by the Claims Examiners for accuracy. The claims are selected for audit on a random selection basis and those claims that exceed individual Claim Examiner authority limits.



Responsibilities:

Relying on experience and knowledge, the Senior Claims Administrator is responsible for accomplishing the following assignments. These assignments reflect substantial variety and complexity and are broad in nature.

  • Review submitted claim documents for sufficient data, verifies that benefits were paid correctly and in accordance with appropriate plans and policies.
  • Responsible for documenting and tracking results in designated format and timeframes.
  • Assist manager in identifying trends, weaknesses, and strengths for insight to the team’s quality and understanding of the work. Includes developing training materials, and conducting training sessions with staff.
  • Assist supervisor with the claim appeal process which may include performing the necessary research, documenting the results of the research, forming a recommendation, and drafting correspondence. Approve appeals up to a set authority limit; anything above the authority limit will be referred to management for approval.
  • Assist supervisor with system procedures relating to adjustments, voids, cancellations, or reimbursements. Communicate with Accounting regarding: returned claims checks – due to wrong address info; as requested by the Claims department; or as submitted due to provider corrections.
  • Recommend changes to the Claims Procedural manual. Update manual as necessary with changes.

Job Requirements



Position Knowledge, Skills, and Requirements:

Education

  • High school diploma or equivalent

Experience

  • Minimum of five years of relevant and progressive experience 

Other

  • Possess and have ability to apply advanced knowledge of principles, practices, and procedures
  • Requires strong medical knowledge, including International Classification of Diseases (ICD), Current Procedural Terminology (CPT), HIPAA, and medical terminology
  • Ability to read and interpret documents such as Plan of benefits, contracts, claim reports, and procedural manuals
  • Excellent written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy
  • Advanced organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously
  • Intermediate proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word)

If your experience matches these requirements, please apply WITH A COVER LETTER INCLUDING SALARY REQUIREMENTS.

Tokio Marine HCC offers a competitive salary and employee benefit package. We are a successful, dynamic organization experiencing rapid growth and are seeking energetic and confident individuals to join our team of professionals. Tokio Marine HCC and its subsidiaries are equal-opportunity employers. Please visit www.tmhcc.com for more information about our companies.

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