Claims Liaison (CL)

The Claims Liaison is responsible for the oversight of all aspects of operational support for the claims processes, including all administrative tasks as further described herein. The CL is the point of contact for claimants/members who have questions regarding the claims management process and are responsible for providing support to the Nurse and/or Medical Provider. The CL also assists with operations or quality projects, as deemed necessary. 

 

 

Job Description

Role and Responsibilities

·         Act as a mentor for new staff, including coordination of training schedules, training resources, and competency assessments.

·   Maintain a comprehensive understanding of MMROs services and processes, including but not limited to, client processes, timeframe requirements, Key Performance Indicators (KPI’s), among others.

·         Monitor daily workflow to ensure appropriate turnaround times while balancing workload.

·  ·         Initiate claims from the client to determine whether all required documentation was received.

·         Open, sort, and distribute appropriate incoming correspondence, including U.S. mail, faxes, email and/or UPS/FedEx, as needed.

·         Assist with tracking and trending department turnaround times for reporting purposes.

·         Maintain confidentiality in all aspects of client, staff, and organizational information.

·         Perform general clerical duties to include, but are not limited to:  copying, scanning, faxing, mail merging, mailing, and filing, as deemed necessary. 

·         Upload documents into appropriate area, as applicable. 

·         Other duties, as deemed appropriate.

 

Required Qualifications and Education

·         A minimum of two (2) years related experience or High School diploma or GED

·         Demonstrated competency in Microsoft Office software applications and software applications related to work performed or a thorough knowledge of computer operation and software applications

·         Advanced data entry skills

·         Knowledge of medical terminology

·         Ability to work independently

·         Strong organizational skills with attention to detail

·         Ability to prioritize workload

·         Excellent verbal and written communication skills

·         Excellent customer service skills

·         Experience in applying general office policies and procedures and handling of confidential information

·         Ability to work well under pressure, and to meet multiple and sometimes competing deadlines

 

Preferred Skills and Additional Experience

·         Advanced computer skills

·         Prior experience in claims handling

·         At least one-year experience performing telephonic customer service support and data entry, in a medical/clinical environment

 

ADA Requirements

Physical/Mental Demands:

Normal office environment.  Stressful conditions may arise when workload becomes more demanding than normal.  The physical requirements of the job are considered Sedentary Work per the U.S. Department of Labor, which is work involving the exertion of up to 10 pounds of force occasionally or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary Work involves sitting most of the time but may involve walking or standing for brief periods of time.


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