HEALTH INSURANCE BENEFITS CLERK
New Jersey classifies Health Insurance Benefits Clerk as non-competitive, which skips the exam-and-list step and turns on whether you meet the minimum requirements.
The main requirement is 2 years of relevant experience.
How to apply
This title is not filled by examination — agencies appoint directly.
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Health Insurance Benefits Clerk is a local service title. It is filled by the counties, municipalities, authorities and other employers that have adopted civil service under Title 11A, not by State departments. Those employers set pay by ordinance or contract rather than from a State salary schedule, which is why most local titles carry no salary range here.
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Official job specification
The text below is the official specification published by the New Jersey Civil Service Commission. The plain-language summary and analysis above are derived from it by NJ Civil Service Navigator. Source: the official specification page at NJ CSC.
Definition
Under direction, performs complex, varied work involved in processing (examining, verifying, and computing) insurance health claims documents; may have charge over a small clerical unit; does other related duties as required.
Examples of work
- Reviews records such as hospital admitting forms to ascertain type and name of company or government agency providing part or all of coverage.
- Records necessary identification data such as policy number, name of policyholder, and physician's name on forms, and obtains signatures so that claim may be submitted to proper carrier.
- Contacts insurance company or government carrier by phone or letter to verify information such as coverage and extent of benefits or, in the case of unpaid claims, to obtain settlement of claims.
- Computes charges to be paid by insurance company or patient by using adding or calculating machines.
- Completes form outlining expenses for financing company or agency to give details of bills for specific patients.
- May refer unpaid bills to another unit so that proper action can be taken or responsible party/patient can be contacted.
- Performs other clerical work of a general nature such as receiving and sorting mail, filing, searching files and other information sources, composing correspondence and sending form letters, answering telephone inquiries, and so forth.
- Collects information for various source documents to prepare statistical or narrative reports.
- May assist in supervising the operation or functions of a small work unit involved in processing insurance health claims documents; when employees are assigned to such a unit, the position carries responsibility for training, work assignment, review of work, and answering work related questions.
- Will be required to learn to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units.
Experience
Two (2) years of experience in work involving the determination of insurance, welfare, or social service benefits or services.
License
Appointees will be required to possess a driver's license valid in New Jersey only if the operation of a vehicle, rather than employee mobility, is necessary to perform essential duties of the position.
Knowledge, skills and abilities
- Knowledge of office methods, practices, routines, and equipment as they relate to clerical processing of health insurance claims forms and bills.
- Knowledge of basic arithmetic.
- Knowledge of medical and insurance terminology.
- Ability to compute billing accounts and to use an adding or calculating machine.
- Ability to communicate verbally and in writing when exchanging information with patients and insurance company representatives.
- Ability to carry out procedures according to established standards.
- Ability to work independently, to locate errors, and to resolve discrepancies.
- Ability to take the lead over other employees.
- Ability to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units.
- Ability to read, write, speak, understand, and communicate in English sufficiently to perform duties of this position. American Sign Language or Braille may also be considered as acceptable forms of communication.
- Persons with mental or physical disabilities are eligible as long as they can perform essential functions of the job after reasonable accommodation is made to their known limitations. If the accommodation cannot be made because it would cause the employer undue hardship, such persons may not be eligible.
- CODES: LG - RKR/hw 10/21/97
- This job specification is for local government use only.
Note
The examples of work for this title are for illustrative purposes only. A particular position using this title may not perform all duties listed in this job specification. Conversely, all duties performed on the job may not be listed.