Insurance Services Representative

Job Summary

The Insurance Services Representative is responsible for ensuring the timely and accurate processing, submission, follow-up, and resolution of healthcare insurance claims. The incumbent reviews claims for accuracy, monitors aged accounts, investigates denials, and works collaboratively with internal departments and insurance carriers to facilitate prompt reimbursement and maintain revenue cycle integrity.

This role also supports customer service functions related to insurance billing inquiries, payment posting, denial resolution, and improvement initiatives.

Essential Functions

Scrub insurance claims for errors and coordinate corrections with applicable departments. Process account reconciliation while contributing to departmental performance improvements and submit insurance claims accurately and within required timelines. Monitor claims data entered into the computer system for accuracy and completeness.

Follow up on unpaid or aged claims/accounts exceeding 30 days from submission. Log, track, review, and investigate insurance denials and challenge denials where appropriate. Monitor and ensure explanations of benefits (EOBs) requiring action are addressed promptly. Forward EOBs to responsible parties for reimbursement processing.

Prepare monthly aged receivables reports for insurance carriers and management review by established deadlines. Prepare and distribute Balance After Insurance (BAI) statements to patients through the automated billing system. Ensure claims and payments are accurately entered and appropriately classified within the financial system.

Post payments, adjustments, and discounts to the correct accounts. Maintain organized filing systems for claims and insurance-related documentation. Develop and maintain positive working relationships with insurance carriers to support timely reimbursement. Respond to patient and customer inquiries regarding insurance claims, billing concerns, and reimbursement disputes.

Participate in departmental performance improvement and revenue cycle initiatives. Assist with investigations related to billing complaints and account discrepancies. Ensure office supplies and equipment necessary for prompt service delivery are maintained. Perform routine quality checks on claims to ensure compliance with payer requirements and organizational standards.

Consistently report to work on time and maintain reliable attendance. Perform additional duties as assigned by the Supervisor or Management. Non-Essential Functions: Participate in departmental meetings, training sessions, and continuing education activities. Support special projects and workflow improvement initiatives within the Insurance Services Department.

Cross-train in other functional areas as required. Perform other related duties as assigned.