Claims Payment & Resolution Specialist

South Kansas City,, MO

Post Date: 06/09/2017 Job ID: 52493 Industry: Insurance Pay Rate: $16/hr

 Large employer near the Ward Parkway Shopping Center is looking for an individual with claims payment experience to work 6 months or longer . 


Role and Responsibilities

The EAP Claims Payment & Resolution Specialist ensures timely entry and payment of EAP claims and researches claims payment inquiries. The position requires communication with providers, billing managers, and internal staff. Also need fast and accurate data entry skills, working experience with Word, Excel and Outlook.



·         Daily manual entry into computer of clean EAP claims, assuring accuracy and timeliness of EAP claims payment for all services rendered in patients’ account

·         Complete weekly closing and balancing of EAP claims

·         Communicate with providers regarding unclean and denied claims

·         Works with Customer Service and Network Operations regarding EAP provider questions and claims payment issues, assuring timely research and resolution of questions and concerns, and note resolution where appropriate

·         Work with Account Management, Care Management, Provider Relations and Finance Staff regarding various File-Specific inquiries and note resolution where appropriate

·         Manage departmental correspondence and mail

·         All other duties as assigned.

·         Adheres to New Directions Behavioral Health Mission Statement, Core Values, Code of Business Conduct, and Compliance Program.

·         Complies with all Federal and applicable State laws and New Directions Behavioral Health Policies regarding, privacy, confidentiality, and security of health information, and other designated information.



This list of duties and responsibilities is not intended to be all-inclusive and can be expanded to include other duties or responsibilities as deemed necessary.








·         Associates Degree or 2-3 years of relevant experience

·         Excellent oral and written communication skills and an ability to communicate effectively with all levels of the organization.

·         Excellent reasoning abilities and experience with coordinating projects

·         Highly organized, quick learner, detail oriented

·         Ability to work independently & as part of a productive team

·         Ability to handle multiple and conflicting priorities

·         Works with a professional demeanor under pressure

·         Must be able to work with minimal supervision

·         Proficient with Microsoft Office (Word, Excel, Power Point and Outlook)



·         Experience with EAP Products

·         Experience with claims payment



·         Excellent Communication skills verbally and in writing

·         Collaborative

·         Flexible

·         Must be detail-oriented

·         Independent

·         Responsible

·         Self-disciplined

·         Ability to meet defined performance and production

·         Ability to effectively present information to employee at all levels of the organization.

·         Ability to think critically and apply information to improve processes.

·         Ability to manage time, prioritize and multi-task.










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