Claims Representative

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

📋 Description

• Conduct manual reviews and processing of medical, supplemental, or dental claims.

• Process claims in accordance with benefits, eligibility, and established internal processes, policies, and procedures.

• Complete, hold for further information, or deny claims as appropriate.

• Research and navigate through documents and databases to ensure claims are processed accurately and in compliance.

• Verify that all necessary documents are included in the submitted claims.

• Validate medical codes in claim submissions.

• Assess the eligibility of claims.

• Review and confirm information regarding other insurance coverage.

• Evaluate authorizations for correctness.

• Analyze account benefit plans to ensure claims conform with coverage and policies.

• Identify discrepancies, errors, and missing information.

• Utilize multiple computer applications concurrently.

• Achieve or surpass quality and productivity targets.

• Collaborate with supervisors, coaches, and trainers to enhance processing techniques and workflows.

• Use Outlook, Cisco Webex, and similar virtual tools for collaboration and communication with colleagues and supervisors.

• Complete a comprehensive training program and meet accuracy, quality, volume, claims-per-hour, and production metrics following training.

⛳️ Requirements

• High school diploma or equivalent qualification.

• Capability to quickly master a variety of computer applications.

• Experience with sending and receiving emails, scheduling calendar appointments, sending invitations, and attaching files in Microsoft Outlook.

• Familiarity with basic Microsoft Excel functions, such as filtering and sorting.

• Experience in navigating multiple computer applications using shortcut keys and other techniques.

• Detail-oriented with experience in applying complex policy and procedure documents.

• Strong organizational skills with the ability to prioritize tasks effectively to meet deadlines.

• Demonstrated experience in meeting quality and productivity performance standards.

• Experience working independently in a virtual environment is preferred.

• Familiarity with medical and insurance terminology in a professional context is preferred.

• Knowledge of CPT/ICD-10 codes is preferred.

• Proven experience in health insurance claims processing or a related field is preferred.

• High-speed cable broadband or fiber optic internet service with a minimum of 10 Mbps download and 5 Mbps upload is required when working from home.

🏝️ Benefits

• Eligibility for an annual bonus plan.

• Medical, vision, and dental benefits commence on day one.

• Well-being and behavioral health programs available.

• 401(k) retirement plan.

• Company-paid life insurance coverage.

• Tuition reimbursement opportunities.

• A minimum of 18 days of paid time off each year.

• Paid holidays provided.

• Leaves of absence available.

• A thorough training program that includes virtual classroom instruction, on-the-job learning, and feedback.