Michigan Conference of Teamsters Welfare Fund
**THIS POSITION IS TEMPORARILY REMOTE AND MAY RETURN TO AN OFFICE SETTING AT A FUTURE DATE
The Fund has an immediate opening for a Claims Processor, Level 5. This is an hourly position which is represented by OPEIU Local 42.
The essential functions of the position include, but are not limited to:
Extensive use of multiple electronic systems to:
- Review medical claims to ensure completeness and accuracy.
- Authorize claims for payment or reject payment and update the claim with the appropriate rejection code.
- Place in hold status any claim that requires review or correction. Update system to document status of claims sent to Blue Cross Blue Shield (BCBS) for reversal.
- Process dental claims. Return to Delta Dental or the provider those claims that cannot be processed by MCTWF staff.
- Access the CVS/Caremark system to check National Drug Code numbers to determine the co-pay on prescriptions that require manual processing
- Update Basys system to reflect that a participant and/or dependent is not eligible for coverage of claims for services covered by a work, auto, or third – party claim. Notify Benefit Recovery of update for pursuit of overpayment as appropriate.
- Update system to document status of claims sent to Blue Cross Blue Shield (BCBS) for reversal.
- Process Loss of Time (LOT) claims on the Basys system. Review each submission for accuracy and updated information. Verify eligibility and perform system updates. Notify Benefit Recovery of changes in eligibility for pursuit of overpayment as appropriate.
- Process initial Total and Permanent Disability (TPD) claims in the Basys system and maintain related files. Gather all necessary information and documents to process these claims.
Investigation of claims:
- Conduct investigation of participants who have other insurance coverage to determine coordination of benefits (COB). Gather all necessary information and update Basys and PCMACS systems accordingly. Process claims placed on hold pending outcome of COB investigation.
Monitor and follow-up on correspondence:
- Review and distribute responses to letters requesting additional information. Update Basys system based on the information received. Monitor all incoming faxes for distribution to staff. Send claims to the appropriate area for processing.
Perform other duties as assigned.
Preferred qualifications include:
- Minimum of 2 years of prior claims experience
- Minimum of 2 years of experience in a healthcare environment
Job Type: Full-time
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
- 8 hour shift
The position is temporarily remote. When working onsite, all staff are required to wear a mask and maintain social distancing guidelines.
- healthcare claims: 2 years (Required)
- Customer service: 2 years (Required)
Work Location: One location