Company Statement
ConnectiCare is a leading health plan in the state of Connecticut. ConnectiCare’s mission is to make it easy for members to get the care they need. A local company for over 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. A subsidiary of EmblemHealth, ConnectiCare leads the individual and small group markets in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance.
We’re looking for individuals who want to make a difference in the communities we serve. If you want to join a local team and help change the way health care is delivered, ConnectiCare is the place for you.
Senior Claims Adjuster (Albany)
Description of Duties:
- Evaluate medical claims that suspend within the Medical Claims System utilizing EmblemHealth’s PPO proprietary conventional coding structure. Apply all PPO Coding & Pend desktop procedures during edit resolution.
Correct claims as required for settlement utilizing established policies and procedures.
Utilizing Claims Operation’s C-More Adjudication Guidelines portal, reference QA memorandums, training guidelines, departmental memos, PRG’s, etc. and apply business rules to claims as instructed for adjudication.
As necessary, manually price claims utilizing the appropriate rate files while considering the provider’s network and the beneficiary’s insurance policy. The ability to interpret contract files and apply to adjudication of pended claims.
As needed, access PPO’s PC Helper applications such as CWI-Viewer Application, Anesthesia Calculator, PC History Look-Up and any other helper application developed by EmblemHealth to support claims processing.
Perform related duties as assigned.
Qualifications:
Knowledge of medical terminology preferred
Minimum of (1) year prior claim processing experience preferred
Ability to compose concise, clear letters
Must pass an online Data Entry Assessment
Must pass a job-related written Claims Simulation
High school diploma or GED required
Test Subjects:
- Claims Simulation & Data Entry Assessments
EEOC Statement
We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.