Senior Claim Benefit Specialist, Operations – Encounters

This is a fully remote position, open to applicants in Alabama, +38 more locations.

📋 Description

• Conduct thorough research, review, and adjudication of intricate, sensitive, and specialized encounters in line with state-specific processing guidelines.

• Facilitate prompt resolution of encounter discrepancies utilizing available resources, tools, and research methodologies.

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

• Fulfill quality and production standards effectively.

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

• Collaborate across functions to eliminate barriers to encounter acceptance.

• Play a role in the development of desktop resources and standardized procedures.

• Manage competing priorities while providing support across multiple markets.

• Engage in working sessions and meetings aimed at advancing business objectives and key performance indicators (KPIs).

⛳️ Requirements

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

• Background in a production environment.

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

• Proficient in MS Office Suite applications: Excel, Word, OneNote.

• Ability to function independently as well as part of a team.

• High School Diploma required.

• Preferred experience with QNXT or Facets claims processing.

• Preferred experience with Medicaid or Medicare claims.

• Preferred experience with encounters.

• 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, subject to eligibility.