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J196901

PPO Repricer I

Highmark Inc.

  • Company Highmark
  • Plymouth Meeting, PA
  • Claims
  • Full time
  • Day (United States of America)

Company :

Highmark Inc.

Job Description : 

Duties Note: The following is not intended to be an exhaustive list of all duties required of this position. ADA E1. Process PPO workload assigned. Maintain production and quality standards. Monitor workflow reports to insure backlog is current and jobs are appropriately prioritized. Maintain knowledge of standard operating procedures. (60%) E2. Provide excellent communication and service with membership, clients, PPOs, management, peers and other areas within the organization. Work with external PPOs and claims staff to resolve PPO repricing issues. (40%) N3. Perform other duties as assigned. Education/Experience/Skills Requirements Required Education: HS/GED Required Experience: Knowledge of claims terminology is preferred. Required Knowledge/Skills: 1. Knowledge of insurance or claims terminology and ability to work in a fast paced production environment 2. Excellent communication skills both verbal and written 3. Organizational skills and detail oriented 4. Computer experience 5. Excellent decision and judgment skills 6. Ability to work independently and with the team Required Licenses/Certifications: Problem Solving Ability to research and seek assistance through resources provided to insure resolution on repricing issues or correspondence is completed. Must be able to multi-task and follow-up at appropriate intervals. Raise concern with management on workload or issues in a timely manner. Managerial/Supervisory Responsibilities Does this Position have Supervisory Responsibility? No Number of Emps Supervised: Titles of Employees Supervised: Financial/Budgetary Responsibilities: Other Job Specifications: External Contacts: Working Conditions/Physical Demands:

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice


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