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Full time (40 hours weekly)

8:00a-4:30p Monday- Friday

General Summary

Performs a variety of duties related to the processing and paying of medical insurance claims. Communicates with claimants, providers and third party payors to answer questions and resolve problems. Enters/retrieves a variety of claims related data into/from computer, maintaining confidentiality. Pays, denies and/or excludes claims according to the plan document.

Duties and Responsibilities

Essential Functions:

+ Sorts claims by category and enters appropriate information into computer.

+ Adjudicates claims and makes payments, denials and/or exclusions according to the plan document.

+ Reviews claim information for accuracy, completeness and consistency.

+ Applies the appropriate coordination of benefits rules, investigates pre-existing conditions and subrogation, and

+ determines appropriate level of benefits based on medical emergency criteria.

+ Investigates processed claims in response to inquiries, questions and complaints from providers, claimants and third party payors.

Common Expectations:

+ Maintains established policies and procedures, objectives, quality assessment and safety standards.

+ Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Minimum Education:

+ High School Diploma or GED Required

Work Experience:

+ Less than 1 year Relevant experience. Required

Courses and Training:

+ Medical Terminology. Upon Hire Preferred

Knowledge, Skills, and Abilities:

+ Basic computer skills.

+ Good typing and communications skills.

Benefits Offered:

+ Comprehensive health benefits

+ Flexible spending and health savings accounts

+ Retirement savings plan

+ Paid time off (PTO)

+ Short-term disability

+ Education assistance

+ Financial education and support, including DailyPay

+ Wellness and Wellbeing programs

+ Caregiver support via Wellthy

+ Childcare referral service via Wellthy

Quality of Life

Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.

Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more - within an easy drive of major East Coast cities.

York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.