Claims Examiner

This is a fully remote position, open to applicants in Florida.

📋 Description

• Oversee and execute all Outbound calls while adjudicating claims.

• Adjudicate HP/AD claims effectively.

• Manage all Outbound calls proficiently.

• Must prioritize tasks and adjudicate claims within designated turnaround times.

• The role entails independently researching, reviewing, summarizing, and recommending actions on claims that have received an appeal or grievance due to denial or underpayment.

• Ensure claims are adjudicated according to client/company guidelines and continuously evaluate processes and procedures.

• Address and resolve claims received through email correspondence.

• Candidates must accurately calculate claim amounts for customers.

• Adhere to company regulations regarding HIPAA, confidentiality, and the handling of private health information.

⛳️ Requirements

• Knowledge of medical terminology and human anatomy, coupled with basic math skills for calculating simple and compound interest.

• Exceptional problem-solving abilities with attention to detail, capable of conducting root cause analysis for complex claims.

• A positive attitude and willingness to learn about process dynamics.

• Capable of managing work pressure and delivering results within timelines.

• Experience in handling US HIP claims is essential.

• Familiarity with ICD 10, CPT, surgical procedures, revenue codes, medical terminology, medical documentation, as well as inpatient vs outpatient claims is required.

• Some experience in reading and understanding medical documents is necessary.

🏝️ Benefits

• A collaborative team environment.

• Accountability and the ability to work independently and remotely.

• Eligibility to pass background screenings and drug tests both pre and post-hire, including THC.

• Verification of high school, GED, or college diploma will be provided upon request.

• Timely provision of responses from three professional references.

• Capability to maintain a dedicated remote work environment free from background noise, interruptions, and desk clutter.

• Must ensure a reliable internet connection and access to a smartphone for Multi-Factor Authentication and communication purposes.