Claims Administrator

Job Description

Job Description

The Claims Administrator reports to the Claims Admin and Quality Assurance Manager in the MWG-Administrators TPA Division.

The position is a non-exempt, hourly role and is located at 500 Steed Road, Ridgeland, MS 39157.

GENERAL JOB DUTIES AND RESPONSIBILITIES :

The Claims Administrator will have a complete understanding of insurance claims and coverage. This person will communicate with all TPA Departments, Accounting, and auditors, as well as possibly interacting with groups, claimants, outside carriers, and agents. To perform the job successfully, the employee must be able to perform each essential duty satisfactorily. The requirements listed here are representative of the knowledge, skill, and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Performs all check related functions (Runs, refunds, voids).
• Sends EOB and check files to third party for payment.
• Reports Check Run Totals to Accounting.
• Maintains monthly record of claims paid for account and auditing purposes.
• Processes claims paid reports to the TPA, Marketing, Eligibility, Accounting, and Auditors as requested.
• Ensures new group benefits are set up correctly and sets benefits in CHS.
• Ensures group renewals are set up correctly and updates benefits in CHS.
• Compiles data for month-end and annual financial and compliance reporting.
• Reviews returned checks and enters address corrections into the administrative system(s).
• Handles ECHO voids / reissue of payments and ECHO updates.
• Utilizes MWG-Administrators Policy Administration System and Claims Management Software to verify eligibility.
• Inputs data into MWG-Administrators Claims Management Software.
• Performs other duties as assigned by the Department Manager.

EXPERIENCE AND EDUCATION REQUIREMENTS :

WORKING ENVIRONMENT :

JOB ESSENTIAL REQUIREMENTS :

The following are job functions that an employee must be capable of performing with or without reasonable accommodation.

MWG is an Equal Opportunity Employer, committed to the principles of the EEOC. All employment decisions are based upon each person's qualifications, abilities, and performance. Our company works to provide an environment where human dignity prevails and all employees and applicants for employment receive equal consideration and fair treatment, without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.