JOB REQUIREMENTS: Claims Specialist Administration - 1265 John Q. Hammons Drive, 1265 John Q. Hammons Dr. , Madison, Wisconsin, United States of America Req #1830 Wednesday, April 24, 2024 Group Health Cooperative of South Central Wisconsin. BETTER TOGETHER The Claims Specialist ensures the accurate entry of inpatient and outpatient claims per the data entry guidelines, and ensures the timely processing of claims per the adjudication rules for accurate payment or denial. The incumbent is also responsible for the accurate use of referral guidelines and benefit plans. Other duties include: filing; assisting outside providers, members, and staff regarding claims related questions or issues; and assisting internal staff on complex claims related questions and problems. The Claims Specialist performs under the general direction, guidance, and supervision of the Insurance Operations Manager. The incumbent knows and abides by all Group Health Cooperative of South Central Wisconsin (GHC-SCW) organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner.The incumbent understands our Mission, Vision and Common Values (stated below) and is committed to promote these values in behavior and attitude. Our Mission Statement: We partner with members and the communities we serve to maximize health and well-being. Our Vision: As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve. Our Values: We are a not-for-profit Cooperative We are member-centered We are equitable and inclusive We are quality-driven We are innovative We are community involved GHC-SCW is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees, members, and patients feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard. We believe: Healthcare is a human right. In treating all people with dignity and respect. There is strength in diversity. Equity celebrates our humanity. We are better together. JOB SPECIFIC QUALIFICATIONS High school graduate or equivalent required. One (1) to two (2) years administrative experience in an insurance, healthcare, financial or relevant environment. Previous experience in claims resolution /processing or closely... For full info follow application link. Group Health Cooperative is an Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status or disability. ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/6DB31DA0923F46DE