Health Benefits Claims Examiner

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

📋 Description

• Ensure the accuracy of claims adjudication while upholding quality and turnaround objectives.

• Adjudicate claims related to medical, dental, and vision services.

• Review plan documentation for various groups to appropriately apply benefits during the adjudication of claims.

• Prioritize claims by focusing on the oldest ones first during adjudication.

• Communicate efficiently with internal auditors and the management team.

• Execute other related tasks as assigned.

⛳️ Requirements

• A minimum of 6 months of previous experience in the healthcare or insurance sector related to operations support, which includes provider maintenance, billing, coding, or customer support.

• Experience in healthcare billing or a background with a health insurance carrier or Third-Party Administrator is highly preferred.

• Strong time-management capabilities with the ability to prioritize tasks while maintaining a sense of urgency.

• Excellent interpersonal skills along with strong verbal and written communication abilities.

• Proficiency in keyboarding and Windows is essential.

• Capability to work with Excel spreadsheets.

• Willingness to learn about the TPA industry and new concepts and processes.

• Experience with Blue Care and knowledge of medical coding and terminology is an advantage.

🏝️ Benefits

• Exceptional medical, dental, and vision insurance*

• Biannual employer HSA contributions that cover 50% of the HDHP plan’s annual deductible!

• Basic Life and AD&D insurance provided by the company

• Company-funded Short-Term and Long-Term Disability coverage**

• Flexible Spending Accounts*

• 401(k) Retirement Plan with an employer match of up to 6%**

• WOW! (100% fully vested after 3 years)

• More than 10 paid holidays

• Half-day Summer Fridays

• Generous paid vacation and sick leave

• Annual Paid Volunteer Day

• Annual Tuition Reimbursement

• Annual Health and Wellness Reimbursement

• Numerous enjoyable company events