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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates proficiency in Supplemental Health claims processing, including verifying medical codes and eligibility, while maintaining compliance with regulatory requirements. Excels in using various reporting systems and Microsoft Office applications to enhance productivity and accuracy.
Highest-signal resume keywords
Health Insurance Claims ProcessingCPT/ICD-10 Code KnowledgeMicrosoft Office ProficiencyAttention to DetailProblem-Solving Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingMedical Code VerificationPolicy InterpretationDocumentation ReviewData Entry
Soft Skills
Organizational SkillsInterpersonal CommunicationWritten CommunicationCustomer ServiceTime Management
Tools & Technologies
EMOS ToolsDPLPerformance ProfileRing MasterSAM3
Industry Keywords
Supplemental Health ClaimsBenefit EligibilityRegulatory ComplianceInsurance TerminologyFast-Paced Environment
Tech Stack
Tools & technologiesCognos
About the role
Key responsibilities & impact- Accurately and timely process Supplemental Health claims
- Review claim submissions and confirm required documentation
- Verify medical codes, eligibility, other insurance, authorizations, and account benefit plans
- Interpret policy provisions and determine benefit eligibility
- Pay, pend for additional information, or deny claims according to established policies and procedures
- Manage pending claims and issue claim decisions
- Participate in virtual team huddles, supervisor one-to-ones, and check-ins using virtual tools
- Meet or exceed established quality, productivity, KPI, and performance standards
- Identify discrepancies, errors, and missing information
- Use eMOS tools and reporting systems, including DPL, Performance Profile, Ring Master, SAM3, and other systems
- Partner with the Resource Management Group on WFT, COGNOS pend report claims, and inventory issues
- Work with supervisors, coaches, and trainers to improve claim-processing techniques and workflows
- Maintain confidentiality and compliance with company policies and regulatory requirements
Requirements
What you’ll need- High School diploma or equivalent
- Strong attention to detail and problem-solving skills with a high level of accuracy
- Ability to navigate multiple computer applications using shortcut keys and other techniques
- Proficiency in Microsoft Office applications, including Word, Excel, Outlook, OneNote, and PowerPoint
- Knowledge of medical and insurance industry terminology, including CPT/ICD-10 codes
- Proven experience in health insurance claims processing or a similar field preferred
- Excellent organizational, interpersonal, written, and verbal communication skills
- Ability to prioritize tasks and complete work before deadlines
- Experience delivering exceptional customer service
- Ability to perform comfortably in a fast-paced, deadline-oriented work environment
- Ability to type and use a keyboard for extended periods
- Integrity and personal accountability for job performance and expectations
- Ability to interpret policy language and apply complex benefit provisions
- Cable broadband or fiber optic internet connection with at least 10 Mbps download and 5 Mbps upload for home-based work
Benefits
Comp & perks- Annual bonus plan eligibility
- Medical, vision, and dental benefits starting on day one
- Well-being and behavioral health programs
- 401(k)
- Company-paid life insurance
- Tuition reimbursement
- Minimum of 18 days of paid time off per year
- Paid holidays
- Leaves of absence
- Virtual classroom instruction and on-the-job coaching during training