Job Description

The Southern California Pipe Trades Administrative Corporation is seeking a Claims Processor in the Health & Welfare Benefit Funds Department. This is a Grade 3 union position that offers competitive pay as well as health and pension benefits.

EXPERIENCE & GENERAL JOB REQUIREMENTS:

• High school diploma or GED.
• Experience with Microsoft Office including Word, Excel, and Outlook.
• Must be detail oriented and have strong organizational skills.
• Must have the ability to expedite work to meet deadlines with minimum supervision.
• Must maintain confidentiality of documents processed.
• Knowledge of medical terminology and coding preferred.

JOB RESPONSIBILITIES:

The most significant responsibilities of this job classification are:

• Review and resolve submitted claims by initiating payment or denial in line with eligibility and benefits as described in the applicable Summary Plan Description.
• Communicate with the appropriate party to obtain additional documentation where necessary.
• Provide proper and timely response to Member and provider inquires on all non-complex claims.
• Review and resolve submitted claims through our HRA and WEX systems, ensuring that claims meet our guidelines before releasing payments.
• Familiarity with Innovative Software Solutions Inc. (ISSI) and WEX platforms.

Other responsibilities will be assigned by Management based on the individual's abilities.

NOTES:

• Background screening and educational verification will be conducted on individuals offered employment.

The Southern California Pipe Trades Administrative Corporation is subject to the Los Angeles Fair Chance Initiative for Hiring Ordinance (FCIHO) (LAMC 189.00) and will consider for employment any qualified Applicants with criminal histories in a manner consistent with the requirements of FCIHO.

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