HEALTH INSURANCE BENEFITS CLERK

 

DEFINITION


 Under direction, performs complex, varied work involved in processing
 (examining, verifying, and computing) insurance health claims
 documents; may have charge over a small clerical unit; does other
 related duties as required.

 NOTE: The examples of work for this title are for illustrative
 purposes only. A particular position using this title may not perform
 all duties listed in this job specification. Conversely, all duties
 performed on the job may not be listed.

 
EXAMPLES OF WORK:


 Reviews records such as hospital admitting forms to ascertain type and
 name of company or government agency providing part or all of
 coverage.

 Records necessary identification data such as policy number, name of
 policyholder, and physician's name on forms, and obtains signatures so
 that claim may be submitted to proper carrier.

 Contacts insurance company or government carrier by phone or letter to
 verify information such as coverage and extent of benefits or, in the
 case of unpaid claims, to obtain settlement of claims.

 Computes charges to be paid by insurance company or patient by using
 adding or calculating machines.

 Completes form outlining expenses for financing company or agency to
 give details of bills for specific patients.

 May refer unpaid bills to another unit so that proper action can be
 taken or responsible party/patient can be contacted.

 Performs other clerical work of a general nature such as receiving and
 sorting mail, filing, searching files and other information sources,
 composing correspondence and sending form letters, answering telephone
 inquiries, and so forth.

 Collects information for various source documents to prepare
 statistical or narrative reports.

 May assist in supervising the operation or functions of a small work
 unit involved in processing insurance health claims documents; when
 employees are assigned to such a unit, the position carries
 responsibility for training, work assignment, review of work, and
 answering work related questions.

 Will be required to learn to utilize various types of electronic
 and/or manual recording and information systems used by the agency,
 office, or related units.

 REQUIREMENTS:

      EXPERIENCE:

       Two (2) years of experience in work involving the determination
 of insurance, welfare, or social service benefits or services.

      LICENSE:

       Appointees will be required to possess a driver's license valid
 in New Jersey only if the operation of a vehicle, rather than employee
 mobility, is necessary to perform essential duties of the position.

 KNOWLEDGE AND ABILITIES:

 Knowledge of office methods, practices, routines, and equipment as
 they relate to clerical processing of health insurance claims forms
 and bills.

 Knowledge of basic arithmetic.

 Knowledge of medical and insurance terminology.

 Ability to compute billing accounts and to use an adding or
 calculating machine.

 Ability to communicate verbally and in writing when exchanging
 information with patients and insurance company representatives.

 Ability to carry out procedures according to established standards.

 Ability to work independently, to locate errors, and to resolve
 discrepancies.

 Ability to take the lead over other employees.

 Ability to utilize various types of electronic and/or manual recording
 and information systems used by the agency, office, or related units.

 Ability to read, write, speak, understand, and communicate in English
 sufficiently to perform duties of this position. American Sign
 Language or Braille may also be considered as acceptable forms of
 communication.

 Persons with mental or physical disabilities are eligible as long as
 they can perform essential functions of the job after reasonable
 accommodation is made to their known limitations. If the accommodation
 cannot be made because it would cause the employer undue hardship,
 such persons may not be eligible.

 CODES: LG - 01985              RKR/hw                     10/21/97

 This job specification is for local government use only.