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Claims Data Entry and Mail Coordinator
Department:

Claims
Effective Date:

December 1, 2019

Reports to:

Claims Manager
Direct Reports:

None
FLSA:

Non-Exempt

Working Conditions: Normal, no adverse or hazardous conditions.

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Primary Purpose:

To process the medical claims of the company’s IPA clients pursuant to designated production quotes

for accuracy and productivity benchmarks.

Principal Duties and Responsibilities ( = essential functions):

• Accurately sort incoming claims mail, prepare batches for scanning, scan, and file claims received

the appropriate databases.

• Maintain organized claims documents in designated storage areas and purge older documents per

• Perform claims data entry tasks and accurately transfer data from claim images into MedMC.

Apply Action Codes to pend claims (when appropriate).

• Complete all steps above within designated timeframes and notify management if claims cannot be

• Document issues that affect claims processing quality and advise claims manager with

• Research and resolve OCR scanning errors in QuickClaim software.

Answer calls from members, providers and health plans regarding specific claim issues. Route and
redirect calls as necessary. Perform timely follow-up on calls requiring research and call back. Use

MedMC to log incoming call and resolution of the call.

Accurately interpret DOFRs – Division of Financial Responsibility documents that determine who
pays for specific health care services (PDT, health plan or other).

Provide administrative support to Claims Manager or Senior Claims Specialist, including but not
limited to, copying and filing documents, printing and routing incoming claims faxes to the

appropriate recipient.

Treat peers, superiors, subordinates, clients and vendors with fairness, courtesy and professionalism
and contribute to the overall positive work environment of the department and the Company.

Complete other duties as assigned by supervisor.

Job Specifications (KSAs):

Requires the ability to speak, read, write and understand English and other general educational skills
as is generally obtained by completing high school or a GED.

Knowledge of managed care claims processing as is generally obtained through 1 year claims
experience.