Senior Claim Benefit Specialist – Operations, Encounters

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

📋 Description

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

• Facilitate prompt resolution of encounter errors through the utilization of available resources, tools, and research.

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

• Achieve quality and production targets.

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

• Collaborate across functions to eliminate barriers to encounter acceptance.

• Assist in the development of desktops and standardized procedures.

• Manage competing priorities while supporting various markets.

• Engage in working sessions and meetings that promote business objectives and KPIs.

⛳️ Requirements

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

• Familiarity with working in a production environment.

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

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

• Capability to work both independently and as part of a team.

• Preferred experience with QNXT or Facets claims processing.

• Preferred experience in Medicaid or Medicare claims.

• Preferred experience with encounters.

• Preferred knowledge of the Edifecs system.

• High School Diploma required.

🏝️ Benefits

• Medical coverage available.

• Dental coverage provided.

• Vision coverage included.

• Paid time off offered.

• Retirement savings options available.

• Access to wellness programs.

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