Claims Specialist

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

📋 Description

• Process and review medical, life, and disability claims

• Utilize specialized knowledge in medical claims processing and perform code review edits

• Detect patterns of fraud and abuse

• Implement PPO reimbursement methodologies and comprehend stop loss coverage

• Investigate claims while making analytical, mathematical, and informed decisions

• Keep accurate and detailed records, thoroughly documenting claim information

• Organize workflow, prioritize tasks, manage multiple responsibilities, and meet deadlines

• Take on additional tasks and projects while providing support to other team members

• Collaborate with colleagues, employees, providers, clients, and other departments

• Adapt to new systems, policies, environments, and methodologies for improvement

• Promote a positive team atmosphere

• Work in a fast-paced, customer service-oriented environment

⛳️ Requirements

• Four years of experience in medical claims processing

• In-depth knowledge of specialized medical claims processing

• Understanding of code review edits and identification of fraud and abuse patterns

• Outstanding verbal and written communication skills

• Exceptional interpersonal abilities

• Performance and audit scores of 99% for payment, 97% for financial, and 97% accuracy or better

• Familiarity with various PPO reimbursement methodologies

• Basic understanding of stop loss coverage

• Proficiency in Microsoft Office applications

• Excellent organizational skills

• Highly detail-oriented

• Capability to collaborate effectively with team members, employees, providers, and clients

• Ability to thrive in a fast-paced, customer service-driven environment

• Strong knowledge of disability and/or life claims and comprehensive understanding of claims examination

• Solid skills in investigation, analysis, and organization

• Attention to detail or an equivalent combination of relevant experience

• Minimum of five years of insurance claim experience with knowledge of medical terminology

• Strong mathematical and decision-making abilities

• Capability to maintain accurate, detailed records and comprehensively document claim information

• Creative problem-solving and conflict resolution skills

• Ability to organize workflow and accept additional projects and tasks

• Strong time management skills

• Ability to prioritize workload, manage multiple tasks, and support other team members

• Capacity to make decisions independently or with minimal supervision

• Excellent verbal and written communication skills

• Ability to handle pressure, interact effectively with other departments, and meet deadlines

• Ability to adjust to new systems, policies, and environments

• Proficient in personal computers and related software

• Skilled in Word, Excel, and Outlook; Access knowledge preferred

🏝️ Benefits

• Health and wellness benefits

• 401(k) savings plan

• Pension plan

• Paid time off

• Paid parental leave

• Disability insurance

• Supplemental life insurance

• Employee assistance program

• Paid holidays

• Tuition reimbursement

• Additional incentives

• Annual incentive bonus plan subject to the plan's terms and conditions

• Flexibility to work remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii

• Drug-free and smoke-free workplace