Oficinista de Reclamaciones

Oficinista de Reclamaciones

Regular

Non-Exempt

GENERAL DESCRIPTION:

Office work involves receipt, classification, and digitization of the claims received and other related documents. Prepares inventory reports by the type of claims received.

ESSENTIAL FUNCTIONS:

• Receives and punches out with the date of receipt of the claims received at the counter and the correspondence.
• Draws and classifies claims and administrative correspondence working by the date of receipt.
• Verifies non-processable or incomplete claims and returns them to providers/policyholders. Prepares letters, labels,

and envelopes for the claims to be returned to the provider or member.

• Deposits the mail at the mailbox in the Mailing Unit to deliver them to the administration messenger for them to

be distributed to different departments. Delivers the correspondence to the departments that require an acknowledgment of receipt.

• Prepares claims for their digitization. Carries out a quality of the "batches" of claims, and post-digitization.
• Receives and validates the classification of claims, accounts, and coordinates the claims received from providers and members that have already been digitized.
• Classifies adjustments, complaints, and special cases.
• Archives claims according to the parameters established for this process and makes a physical inventory of the

claims.

• Prepares inventory reports by the type of claims received, and provider audit reports, among other reports, as

required.

• Performs the pre-process adjustments to determine whether the claims are actionable or not.
• Records and forwards claims to other support departments.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS:

Education and Experience: High School Diploma or Technical Course. At least six (6) months of experience performing tasks in a
similar position.

“Proven experience may be replaced by previously established requirements.”

Certifications / Licenses: N/A

Other: Medical Plan Billing knowledge is preferred. Knowledge of Medical Billing forms such as: CMS-1500, UB-04, and Dental ADA is preferred.

Languages:
Spanish – Basic (comprehensive, writing and verbal)
English – Basic (comprehensive, writing and verbal)

“Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento”