Claims Representative

Tigard, OR | Full-time

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Claims Representative

*2022 Top Workplace*

  • On Demand Care: Immediate Care for Injuries, Illness, Primary Care, and Wellness.
  • A Winning Culture: Supportive Teammates, Transparent Leadership, and Non-Bureaucratic Decision Making
  • Profit Sharing: All Employees Work Together, See the Results, and Share in the Success

Claims Representative Tasks will include but are not limited to working claim denials/appeals, posting EOB payments, calling insurance companies regarding claims, and submitting claims. This position provides high-quality services to patients, contracted occupational health accounts, and insurance companies including, but not limited to Workers’ Compensation Claims. 

Required Education and/or Experience:

  • Minimum of one year of experience working with health insurance plans, required
  • Minimum of one year of Medical Claim knowledge required
  • Experience working with an EMR system is strongly preferred 
  • Ability to communicate effectively and clearly with patients and team members

Pay and Benefits:

  • $19 - $23+ /hr - DOE 
  • Full-Time Benefits Eligible
  • 401k at 1 year, with 3% Employer Contribution
  • 3 Weeks of Paid Time Off
  • All Staff Profit-Sharing bonus program paid quarterly
  • Healthcare services completed at AFC Portland facilities for employees and dependants provided 

Schedule:

  • Full-time, ~40 hrs/week
  • Monday - Friday from 7:30 am - 4:00 pm

In-Person Position:

  • Location: Headquarters offices, 8060 SW Pfaffle St. Suite 106 Tigard, OR 97223

What We Need: We are currently seeking customer service-driven, and team-oriented individuals who have good communication skills, the ability to take high call volumes, accurately explain account balances, excellent phone etiquette, and can work independently to serve the needs of our patients and occupational account reps over the phone. 

Essential Duties and Responsibilities: Attention to detail is a must. The Claims Representative role will be the primary contact for the patient billing line, confirming insurances, obtaining authorizations, troubleshooting billing issues, and responding to requests in a timely manner. 

  • Provide patients, insurance companies, workers' compensation representatives, and adjusters with HIPAA-compliant information as needed.
  • Oversight of patient accounts and accounts receivable accounts.
  • Ability to verbally summarize and give details to patients regarding their compliance, coverage, and when doing commercial: EOB and coverages. Address and correct data for rebilling as necessary.
  • Documenting all correspondences with patients completely in the EMR system.
  • Collecting patient payments over the phone and mailed/faxed checks. Allocated as needed to the appropriate accounts.
  • Posting payments for insurance companies and following up with adjustors.
  • Participate in weekly meetings to clarify claim issues and address accuracy.
  • Creating, sending, and receiving invoices.
  • Working on Worker's compensation claims; denials and approvals, posting of EOBs, and sending corrected claims. This may involve other insurance companies at a later time.

Exhibit Company Core Values:

  • Commitment - Commitments are clearly made and met
  • Health - Healthy living for everyone is promoted through sustainable and responsible behaviors
  • Excellence - Excellence in everything we do
  • Celebrate - Celebrate wins - both small and large
  • Trust - Trust builds teamwork through vulnerability and respect


Safety & Wellbeing:

 

  • Vaccination Policy: As a healthcare company, AFC believes that the safety and well-being of our staff and patients are a top priority. Therefore, we require new hires to have received all required vaccinations, including, but not limited to, measles, mumps, flu, and COVID-19

 

  • Alcohol and Drug-Free Policy: We are an alcohol and drug-free workplace. Offers are contingent on the successful completion of background and drug screenings.