Claims Processor Intern Tufts Health Plan 189 reviews - Watertown, MA 02472 Internship The Core Claims Processor Intern is responsible for the timely and accurate processing of Medicare Preferred claim inventory as assigned by the Core Claims Supervisor. Using basic analytical and problem solving skills, the Core Claims Processor is expected to fully examine and resolve all problem codes initially assigned to each claim. KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS* (in order of importance) % of TIME (Optional) Process core claims as assigned by supervisor: * Examine claim to correct and/or update data so claim can properly adjudicate. * Ensure claim payment is updated to correctly reflect Tufts Health Plan's status as primary or secondary payer through the appropriate coordination of benefits. * Determine member's eligibility if in question. * Check to determine if services rendered on the claim are allowable under the members benefit plan and/or the proper authorization, referrals and pre-registrations were obtained as required by the plan. * Communicate with partner departments (verbally and/or written) to obtain missing information to properly adjudicate claims, such as provider numbers, authorizations and referrals. * Manually calculate and/or apply pricing to each claim when necessary. Process core claims adjustments as assigned by supervisor: * Review adjustment request to determine if re-adjudication of claim is required. * Examine claim to correct and/or update data so claim can properly re-adjudicate.

• Prepare and enter adjustment while applying appropriate back out and adjustment reason codes. * While processing claim adjustment, ensure that claims maintains or is appropriately updated to: o Correctly reflect Tufts Health Plan's status as primary or secondary payer through the appropriate coordination of benefits. o Member was eligible on DOS. o Services rendered on the claim are allowable under the members benefit plan and/or the proper authorization, referrals and pre-registrations were obtained as required by the plan. o Reflect correct pricing, which may need to be applied or manually re-calculated. * Communicate with partner departments (verbally and/or written) to obtain missing information to properly re-adjudicate claims, such as provider numbers, authorizations and referrals. Quality & Production: * Achieve individual standards for quality and production as assigned by supervisor. * Contribute to team and departmental standards for quality and production. * Monitor pending claims and adjustments daily and ensure claims are released timely for adjudication. * Participate in identifying opportunities for overall process improvements. Other: * Participate in initiatives or provide back up support to other areas of department as requested. * Participate in staff & individual meetings and training sessions as required. * Comply with all department and company guidelines and policies. College students with an interest in health care, operations, etc. are encouraged to apply. Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled 1 day ago - save job - original job Apply On Company Site Other jobs you may like Claims Intern Tufts Health Plan - Watertown, MA 3 days ago Creative Intern Hopper - Cambridge, MA 1 day ago Easily apply Interns - Fall 2018 Haley & Aldrich - Boston, MA 3 days ago Claims Processor Agero, Inc. - Medford, MA Agero - 9 days ago Marketing Associate Associated Environmental Systems - Acton, MA 2 days ago Easily apply * Claim Processor Intern jobs in Watertown, MA * Jobs at Tufts Health Plan in Watertown, MA * Claim Processor Intern salaries in Watertown, MA Tufts Health Plan 189 reviews Let employers find you Thousands of employers search for candidates on Indeed Upload Your Resume