Business Associate 2 - Claims

Employment Type: Full time

Position Overview

Pan-American Life Insurance Group (PALIG) is seeking a Business Associate 2 to join the U.S. Benefits, Claims department. The Business Associate 2 Claims will perform all the duties necessary to ensure group members and providers receive proper payment of policy benefits in a timely manner, while providing excellent customer service.

Responsibilities

Duties are to include, but are not limited to:

• Receiving pending claims for evaluation and processing
• Entering and/or reviewing claims data in the claims administration system and adjudicating claims
• Processing claims in accordance with Pan-American Life Insurance Group's company strategy and mandated requirements
• Accurately coding explanation of benefits
• Maintaining claims and task procedural, financial, and timing standards
• Completing special projects as needed

Incumbents are to exercise accuracy, attention to detail, adherence to desk level procedures, and excellence at all times in responding to internal/external customers, regardless of the issue, to meet customer demands. Professionalism, self-directed manner, and continuous process improvement are required to ensure and promote customer satisfaction and retention.

The Business Associate 2 Claims will be responsible for the pending claims inventory. Production rates and procedural and financial standards will be higher than a Business Associate 1 Claims. Employee must have maintained the required procedural and financial QC scores for a minimum of 6 months before advancing to this role outside of special circumstances.

ESSENTIAL FUNCTIONS:

• Process Claims:
  • Adjudicate pending claims
  • Review and pend claims requiring additional research
  • Process claims received and review, research, and reprocess, if applicable, claims from provider and member inquiries or appeals
  • Pricing claims
  • Adjudication of adjustments
• Workbench Tasks:
  • Create workbench tasks, when needed, for additional claims research
  • Ensure workbench tasks are accurately and timely documented
• Miscellaneous Tasks:
  • Miscellaneous tasks such as updating letters and correspondence and communications with Member Services Representatives and other internal and external customers regarding claim status

Key Experience & Requirements

• High school diploma or equivalent
• 2 years of claims processing experience
• Working knowledge of ICD10, CPT codes, and HIPAA guidelines
• Working knowledge of medical terminology
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure
• Must live in a location that can receive high-speed internet connection or leverage an existing high-speed internet service
• Ability to work an 8-hour shift
• Ability to navigate within multiple programs and learn new and complex computer system applications

Knowledge, Skills & Abilities

• Adaptability - Proficient
• Analytical Skills - Proficient
• Attention to Detail - Proficient
• Collaboration – Proficient
• Computer Applications - Proficient
• Multi-tasking Ability - Proficient
• Organization/Planning - Proficient
• Reading/Writing - Proficient
• Standard Keyboard and 10-Key Pad - Proficient
• Work Ethic - Proficient
• Works Well Under Pressure - Proficient

Pan-American Life Insurance Group Offers

• Comprehensive Compensation Packages (base & bonus)
• A Comprehensive Benefits Package: Medical, Dental, 401K, Paid Time Off, and Tuition Reimbursement (etc.) are some examples. New hires are eligible for medical and dental coverage on the first of the month following 30 days of service.
• Hybrid Work Opportunities

Who We Are

Pan-American Life Insurance Group (PALIG) serves the life, accident, and health insurance needs of individuals and businesses in 49 U.S. states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands through its U.S. based member companies - Pan-American Life Insurance Company and Pan-American Assurance Company.

At Pan-American Life, our employees are our greatest asset. We are grateful for the...