Sr. Reconciliation Representative
Carmel, IN 46032
Do you want to be part of a company that supports career progression? For over twenty years, our client has been able to offer first-class salary and superior benefits and career progression to people of all ages, backgrounds, and life circumstances. As an organization their mission is to empower individuals to live longer and healthier lives.Job Summary: A friendly and reliable Reconciliation Representative would be the ideal candidate for our organization. The primary function of this position is to reconcile claims, including complex claims, for payment as per Explanation of Benefits from Health Plan Payors for 2-step accounts.
- Familiarity with Managed Care, HMO, PPO health plan provisions.
- Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
- Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
- Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
- Ability to effectively organize, prioritize, multi-task and manage time.
- Demonstrated accuracy and productivity in a changing environment with constant interruptions.
- Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
- Ability to exercise strict confidentiality in all matters.
- System reconciles ASO claims payment from Health Plan Payors.
- Makes calls to Health Plans to check status of claims which may include payment or underpayment.
- Make courtesy calls to Providers as needed.
- Makes calls and researches overpayment requests from health plan recovery services.
- Documents follow-up in reconciliation system or communication log
- Prepares letters of explanation to Health Plans and prepares spreadsheet documentation of claims disposition/payments/overpayments/underpayments.
- Completes check requests for reimbursements of overpayments to Health Plans.
- Maintains confidentiality of all claims documents, records, and claims related issues.
- Promotes a spirit of cooperation and understanding among all personnel.