Claims Representative

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

📋 Description

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

• Investigate and navigate through various documents and databases to ensure claims are processed accurately and in line with established guidelines.

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

• Confirm the accuracy of medical codes within claim submissions.

• Evaluate claim eligibility for processing.

• Review and validate information regarding other insurance coverage.

• Assess authorizations for correctness.

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

• Identify any discrepancies, errors, or missing information in claims.

• Utilize multiple computer applications simultaneously during the claims process.

• Perform tasks independently without requiring close supervision.

• Achieve or surpass quality and productivity benchmarks.

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

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

⛳️ Requirements

• High school diploma or its equivalent.

• Ability to swiftly learn various computer applications.

• Proficiency in sending and receiving emails, managing calendar appointments and invitations, and attaching files within Microsoft Outlook.

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

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

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

• Strong organizational abilities and capacity to prioritize tasks effectively before deadlines.

• Proven track record of meeting quality and productivity performance standards.

• Preferred experience working independently in a virtual environment.

• Preferred experience with medical and insurance terminology in a professional context.

• Knowledge of CPT/ICD-10 codes preferred.

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

• Reliable home internet connection via cable broadband or fiber optic service with a minimum of 10 Mbps download and 5 Mbps upload speeds.

🏝️ Benefits

• Comprehensive training program that includes virtual classroom instruction, on-the-job learning and feedback, and progressively increasing claims per hour and quality requirements.

• Eligibility for an annual bonus plan.

• Medical benefits.

• Vision benefits.

• Dental benefits.

• Programs focused on well-being and behavioral health.

• 401(k) retirement plan.

• Company-paid life insurance.

• Tuition reimbursement opportunities.

• A minimum of 18 days of paid time off annually.

• Paid holidays.

• Leaves of absence.