Senior Claim Benefit Specialist, Operations

This is a fully remote position, open to applicants in Alabama, +39 more locations.

📋 Description

• Conduct research, review, and adjudicate intricate, sensitive, and specialized encounters in accordance with state-specific processing guidelines.

• Facilitate the prompt resolution of encounter errors utilizing available resources, tools, and investigative methods.

• Accurately adjudicate complex, sensitive, and specialized claims within the claims processing system.

• Achieve quality and production targets.

• Recognize and escalate issues that impact claim payment accuracy or lead to rework.

• Collaborate cross-functionally to eliminate obstacles to encounter acceptance.

• Assist in the development of desktops and standardized procedures.

• Manage competing priorities while providing support across multiple markets.

• Engage in working sessions and meetings to advance business objectives and key performance indicators (KPIs).

⛳️ Requirements

• At least 2 years of experience in medical claims processing (Commercial, Medicaid, Medicare).

• Proven experience in a production environment.

• Strong analytical and problem-solving abilities, particularly in claims research.

• Proficiency in MS Office Suite applications, including Excel, Word, and OneNote.

• Capability to work independently as well as collaboratively within a team.

• High School Diploma required.

• Preferred experience with QNXT or Facets claims processing.

• Preferred experience in Medicaid or Medicare claims.

• Preferred encounters experience.

• Preferred knowledge of the Edifecs system.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being, based on eligibility.