Manual Claims Team Lead
Location: Salem, Oregon
Description: Catamaran is at the momment seeking for Manual Claims Team Lead right now, this position will be settled in Oregon. For complete informations about this position opportunity please give attention to these descriptions. The Manual Claims Team Leader is the front-line information resource for the claim processing professionals to answer questions and assist with escalations. They must have in-depth k! nowledge of claims, client and department specific policies and procedures. In addition, the Team Lead administers the Quality Audit program for the team and provides feedback monthly. The Team Lead also assists in the training of new hires and with refresher training. They are the backup to the Supervisor for the team, when the Supervisor is not present.
Knowledge of all Catamaran manual claims services, processes and procedures
Process manual pharmacy claims, meeting productivity and quality standards.
Verify eligibility of member and status of accounts.
Enter claims in system application, confirm accuracy of response and make changes if required.
Inform manager of any potential or actual system, procedure, plan set up questions and the need for system updates.
Process returns for any claims as required.
Open sort and distribute mail to department staff in an accurate and timely fashion.
File claims for record! retention.
Provides direction and guidance to less experi! enced team members.
Handles escalated and unresolved issues from less experienced team members and maintains 'documentation of escalated issues
Ability to provide side by side training for new and existing staff
Recognizes and recommends areas needing improvement.
Provide department supervisor/manager with accurate daily counts of mail received, returned and pending issue resolution.
Assist with projects daily as assigned
Perform quality audit for all team members, prepare audit results for team members and provide results to Supervisor.
Provide timely feedback to team members on audit results focusing on coaching/training needs.
Prepare team operations metric reporting and ad hoc management reporting.
May provide input into hiring decisions and performance appraisals, but does not necessarily make hiring decisions or conduct performance appraisals.
Assists Supervisor/Manager with the management of daily activities/scheduling of team.!
Assist in updates of department procedures and implementation of new clients.
Adheres to all Catamaran and departmental policies and procedures.
Other duties as determined by management, including special team projects.
KNOWLEDGE, SKILLS AND ABILITY REQUIREMENTS
Able to work quickly and accurately under time constraints.
Math, proofreading, typing, computer and accounting aptitude.
Strong attention to detail.
Able to respond in a calm, professional manner to others.
Ability to plan and prioritize tasks within deadlines.
Knowledge of claims prescription and/or medical terminology.
Ability to professionally communicate orally and in writing to internal and external contacts.
Strong multi-tasking skills.
Ability to carry out instructions furnished in written, oral or diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.
EDUCATION AND ! EXPERIENCE REQUIREMENTS
High School diploma or GED
Minimum of 2! years pharmacy claims processing experience
Advanced data entry skills.
Able to handle sensitive material confidentially.
Pharmacy or healthcare experience a plus.
Intermediate Office skills.
RxCLAIM claim processing experience.
If you were eligible to this position, please email us your resume, with salary requirements and a resume to Catamaran.
Interested on this position, just click on the Apply button, you will be redirected to the official website
This position will be started on: Tue, 25 Jun 2013 15:12:45 GMT