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Claims Assistant (Hybrid) Chicago, IL (Hybrid) The American Medical Association (AMA) is the nation's largest professional Association of physicians and a non-profit organization. We are a unifying voice and powerful ally for America's physicians, the patients they care for, and the promise of a healthier nation. To be part of the AMA is to be part of our Mission to promote the art and science of medicine and the betterment of public health. We continuously work to embed equity in our internal practices and are committed to increasing the diversity of our staff across all levels of the organization. We intentionally work to create the right conditions to enable our employees to feel that they can be their authentic selves and fully participate in the life of the enterprise. We encourage and support professional development for our employees, and we are dedicated to social responsibility. We invite you to learn more about us and we look forward to getting to know you. We have an opportunity at our corporate offices in Chicago for a Claims Assistant (Hybrid) on our AMAI-Admin Operations team. This is a hybrid position reporting into our Chicago, IL office, requiring 2 days a week in the office. As a Claims Assistant (Hybrid), you will compile documents from Administrative system indexed in imaging system and prepare claims not processed by AMAI for delivery to carriers. Validate eligibility and provide plan information and updates to carriers for accurate claim processing. Prepare outgoing claim documents for Disability and OOE claims based on notifications received from AMAI Customer Service. Update AMAI Claim system of corrected provider addresses and terminate incorrect provider records in a timely manner. Review and identify policies for claim documents received via USPS, email, and fax and create corresponding claim records in AMAI Claim system. Provide for continuity of coverage for incapacitated dependents under AMAI supported insurance policies. Provide administrative and clerical support to the Claims Department to maintain timely handling and processing of claims, claim checks, and incoming claims mail. RESPONSIBILITIES: Transmission of Claim Documents/Initial Claim Notifications to Carriers
Prepare claim documents/initial claim notifications for email transmission to carriers for claims not processed by AMAI (AAA, LTC, DIP, OOE).
Verify insured’s eligibility and benefits, create PDF versions of certificates of coverage, and screen prints from Administration system.
Accurately enter key information into each carrier’s verification form and prepare documents for delivery to carriers.
Index copies of claim documents to the appropriate policy records.
Document appropriate policy regarding claim submission to Carrier.
Respond to Carrier requests for additional information regarding coverage.
Claim System Provider File Maintenance
Accurately update the claim system provider records with any new provider requests from the Claims Examiners within same day of receipt.
Investigate provider mail items returned by the Post Office for correct mailing address by searching internet, CMS NPI site, web, and telephone calls.
Terminate corresponding provider records with invalid addresses and create new provider records reflecting the new updated address.
Forward returned documents to correct address when practical.
Notify Claims Examiner of stale dated checks to be re-issued to updated provider address.
Process address change reports provided by vendors.
Report monthly totals of returned and re-mailed to Claims Manager.
Scan claims refund checks and related correspondence into imaging system for processing by claim examiners.
Forward refund checks unrelated to Claims to Finance Department.
Pre-Claim Paper Claim and Correspondence
Pre-claim paper claims received by entering specific information into the claim system.
Correctly identify patients on Claims Adjudication System, select eligible plans, and determine document type, and date of service.
Research unidentified mail/checks by researching Claims and Administrative system for related names and plans.
Forward unidentified mail to the correct area for handling.
Return unidentified documents to sender with appropriate letter if no match is found.
Process Check Tracers for Claims Checks
Review and process requests for check tracers from claims staff, and customer service staff.
Send email inquiries for all AMAI issued claims checks for all carriers promptly. Send emails to appropriate carriers and forward carrier responses to appropriate claims examiners for handling.
Coordination of Coverage Extension for Incapacitated Dependents
Send letters/forms to insured parties for coverage continuation for incapacitated dependents.
Review returned forms for completeness and send to carriers for authorization when necessary.
Send approval/denial letters based on carrier response.
Work with other AMAI units to accurately update Administration system of eligibility for coverage extension.
May include other responsibilities as assigned
REQUIREMENTS:
High school diploma required. Some College preferred.
Basic knowledge of insurance eligibility required.
Strong attention to detail and accuracy required.
Intermediate computer skills including Microsoft Office suite experience.
Motivation to independently complete work and deliver the desired outcome in line with job production and quality standards.
Prior experience with scanning or imaging systems preferred.
Regular and reliable attendance required.
The American Medical Association is located at 330 N. Wabash Avenue, Chicago, IL 60611 and is convenient to all public transportation in Chicago.
We are an equal opportunity employer, committed to diversity in our workforce. All qualified applicants will receive consideration for employment. As an EOE/AA employer, the American Medical Association will not discriminate in its employment practices due to an applicant’s race, color, religion, sex, age, national origin, sexual orientation, gender identity and veteran or disability status.
THE AMA IS COMMITTED TO IMPROVING THE HEALTH OF THE NATION
