• PPO Repricer I

    Highmark Health (Blue Bell, PA)


    Company :

    Highmark Inc.

    Job Description :

    HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve.

     

    This role is based in Blue Bell, PA - the role will work from home the majority of the time however this role will also be the backup for the mail room as well and will need to go onsite to the Blue Bell office during that time.

    Duties

    + Process PPO workload assigned. Maintain production and quality standards. Monitor workflow reports to insure backlog is current and jobs are appropriately prioritized. Maintain knowledge of standard operating procedures. (60%)

    + Provide excellent communication and service with membership, clients, PPOs, management, peers and other areas within the organization. Work with external PPOs and claims staff to resolve PPO repricing issues. (40%)

    + Perform other duties as assigned.

     

    Education/Experience/Skills Requirements

    Required Education:

    HS/GED

    Required Experience:

    Knowledge of claims terminology is preferred.

    Required Knowledge/Skills:

    1. Knowledge of insurance or claims terminology and ability to work in a fast paced production environment

    2. Excellent communication skills both verbal and written

    3. Organizational skills and detail oriented

    4. Computer experience

    5. Excellent decision and judgment skills

    6. Ability to work independently and with the team

    Required Licenses/Certifications:

    Problem Solving

     

    Ability to research and seek assistance through resources provided to insure resolution on repricing issues or correspondence is completed. Must be able to multi-task and follow-up at appropriate intervals. Raise concern with management on workload or issues in a timely manner.

    Managerial/Supervisory Responsibilities

    Does this Position have Supervisory Responsibility? No

    Number of Emps Supervised:

    Titles of Employees Supervised:

    Financial/Budgetary Responsibilities:

    Other Job Specifications:

    External Contacts:

    Working Conditions/Physical Demands:

    Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

     

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    For accommodation requests, please contact HR Services Online at [email protected]

     

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    Req ID: J250252