Sibia Banks Email & Phone Number

• Process routine medical and/or hospital claims in accordance with assigned Plan.• Independently process medical and/or hospital claims; including more difficult or complex claims and adjustments.• Participate in special assignments, reporting and project work as required. • Provide back-up for departments workload as necessary.• Consistently meet established performance standards, including quantity and quality claims processing standards.• Consistently demonstrate… Show more • Process routine medical and/or hospital claims in accordance with assigned Plan.• Independently process medical and/or hospital claims; including more difficult or complex claims and adjustments.• Participate in special assignments, reporting and project work as required. • Provide back-up for departments workload as necessary.• Consistently meet established performance standards, including quantity and quality claims processing standards.• Consistently demonstrate excellent attendance and punctuality.• Independently work remotely from home or in office. Show less

Received claims service calls from various medical providers in regards medical claims inquiries.Researched and resolved various claim issues using Division of Financial Responsibility reference tools,Provider contracts, established policies and procedure, and other resources as needed.Reviewed call log for open or repeat call issues and followed up for resolution within timeframes outlined byEither regulatory agencies or SCAN's policy.Educated providers… Show more Received claims service calls from various medical providers in regards medical claims inquiries.Researched and resolved various claim issues using Division of Financial Responsibility reference tools,Provider contracts, established policies and procedure, and other resources as needed.Reviewed call log for open or repeat call issues and followed up for resolution within timeframes outlined byEither regulatory agencies or SCAN's policy.Educated providers, delegated administrators, and others on SCAN benefit co-pays, policies and procedures,And claims payments and denials.Processes claims and adjustments as directed.Kept current on SCAN policies and procedures, benefits relating to claims payments, and other revisedReference material, processing requirements, and system updates. Show less

Received telephone inquiries in regards to prescriptions claims.Documented all calls in the RxClaim software.Prescription records for internal reporting.Coordinated and facilitated prior authorization requests.Educated clients on plan policies and procedures at every opportunity.

Greater Los Angeles Area

Analyzed member benefits to better meet member's needs. Reviewed benefits pertaining to small and large groupsIdentified deductibles and co-pay amounts for individual policy holders. Facilitated with Claim reimbursement Assured timely payment of claims Identified claim issues and implement solutionsReviewed and correct insurance billing errors.