CLASSIFICATION:

Claims Processor / Call Center Liaison

Full-Time

Salary Grade IV

EXPERIENCE & GENERAL JOB REQUIREMENTS:

High school diploma (Associate's degree preferred). Must be able to communicate courteously and professionally by phone, in writing, and in person. Must have an understanding of Fund operations, medical terminology, diagnosis, provider certification, medical claims, HRA, and prescription claims procedures, as well as strong telephonic and interpersonal skills. Must have good organizational, analytical, and follow-up skills. Familiarity with ISSI, Microsoft Outlook and Excel is preferred.

JOB RESPONSIBILITIES:

The most significant responsibilities of this job classification are:

Review and resolve submitted HRA and medical claims by initiating payment or denial in accordance with eligibility and benefits as described in the applicable Summary Plan Description.
Provide proper and timely response to member and provider inquires on all non-complex claims.
Interact with employees and members effectively to deliver excellent service.
Communicate in writing and verbally with the appropriate party to obtain additional documentation where necessary.
Coordinate processing with outside vendors (BSC, Delta Dental, repricing, medical consultants).
Ownership of at least one intermediate process, including coordination of back-up employees and reporting any backlogs to management.
Serve as back up to Call Center Agents as needed.

Other responsibilities will be assigned by Management based on the individual's abilities.

NOTES:

Background screening and educational verification will be conducted on individuals offered employment.

The Southern California Pipe Trades Administrative Corporation is subject to the Los Angeles Fair Chance Initiative for Hiring Ordinance (FCIHO) (LAMC 189.00) and will consider for employment any qualified Applicants with criminal histories in a manner consistent with the requirements of FCIHO.

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