Pet Claims Analyst - Brea, Columbus, AWE, VIrtual
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Number 54 on the Fortune Magazine 100 Best Places to Work.
Compensation Grade: D1
Ideal candidates for this role will have a minimum of 3 years of Veterinary Technician experience.
JOB SUMMARY: Promptly and effectively handles all new and pending medical claims in accordance with the company policies and procedures; adheres to Department of Insurance regulations. Requests, compiles, and reviews in detail, coverage and/or medical record information in order to determine the correct claim adjudication action. . Enters accurate coding information in the system ensuring that the submitted invoice balances with the system input information to complete the claim adjudication process.
REPORTING RELATIONSHIPS: VPI Claims Supervisor
CORE JOB DUTIES & RESPONSIBILITIES:
Promptly and effectively processes all new and pending medical claims in accordance with the appropriate work flow. Review veterinary diagnosis and codes claims in accordance with policy provisions. Ensures completion of claims by coding and processing or sending claims to appropriate workflow.
Determines coverage (i.e., pre-existing conditions, breed specific and/or hereditary conditions) and approves benefits and eligibility of each claim based on the terms and conditions of the policy.
Accurately processes claims based on established criteria, provider contract plan and employer group provisions.
Requests, reviews and evaluates requested medical records or treatment notes for determination of resolving claims.
Ensures proper documentation in compliance with Company policies and practices. Record the final disposition of claims, including denial and/or issuing payment.
Identifies and notifies management of questionable claims.Identifies and notifies management of questionable risks. Performs other duties as assigned.
MINIMUM JOB REQUIREMENTS:
Education: Undergraduate degree in Biology, Zoology or related Animal Science field preferred.
License/Certification/Designation: State licensing and/or other certification as required. Associates must obtain the required Federal and/or state licenses/registrations within the time period designated by the business unit. Additional licenses/registrations may be required when new products and services are implemented. If an associate fails or is unable to obtain required licenses/registrations within the time period designated by the business unit, the associate maybe ineligible to continue in the position
Experience: 3-5 years of veterinary claims experience or equivalent training in a veterinary Clinic / hospital position under the supervision of a veterinarian veterinarian/veterinary technician preferred.
Knowledge: Proven understanding of veterinary medical practices and treatment. Ability to understand and use VPI’s insurance policies, riders and endorsements and be able to recognize and resolve questionable coverage situations.
Skills/Competencies: Ability to read, analyze, and interpret documents. Ability to solve practical problems. Ability to meet internal customer needs and provide service by informing customers of the claims process and ensuring a positive customer experience. Written and verbal communication skills for contact with policyholders, claimants, physicians, medical staff, etc.
Values: Regularly and consistently demonstrates the Nationwide Values and Guiding Behaviors.
Staffing Exceptions to the above Minimum Job Requirements must be approved by the: hiring manager’s leader and HRBP.
Overtime Eligibility: Eligible (Non Exempt)
Working Conditions: Normal office environment.
ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.
Job Evaluation Activity: 12/2014 DC
Additional Job Description
Job ID: 53933
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