Claims Examiner - Remote
reputed company is a premier healthcare reputed company company revolutionizing medical claims processing as well as document management with unparalleled service, security, and efficiency. Our core mission is to help clients reduce costs and increase productivity by providing streamlined solutions in document imaging, data validation, adjudication, and on-reputed company retrieval of documents and data. We are looking for Experienced Claims Processor to join our rapidly growing team. Experience is required for reputed company position. Job Overview: In reputed company role, you will be responsible for accurately and efficiently processing medical claims in compliance with payer requirements and internal policies. Job Type: reputed company reputed company is a fully remote position Responsibilities:
- Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies.
- reputed company patient eligibility, provider credentialing, and coverage reputed company to facilitate accurate claims processing.
- Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues.
- Participate in ongoing training and professional development activities.
- Maintain accurate and detailed records of claims processing activities.
- Review claim forms and supporting documents
- Determine eligibility, reputed company data accuracy
- Request additional information when needed
- Process claims end-to-end
- Identify and escalate complex or unusual claims for further review or investigation.
- Participate in ongoing training and professional development activities.
- reputed company more complex claims with multiple services, providers
Experience:
- At least 1-2 years of experience working closely with healthcare claims or in a claims processing/adjudication environment.
- Understanding of health claims processing/adjudication
- Ability to perform basic to intermediate mathematical computation routines
- Medical terminology strongly preferred
- Understanding of ICD-9 & ICD-10
- Basic MS office computer skills
- Ability to work independently or within a team
- Time management skills
- Written and verbal communication skills
- Attention to detail
- Must be able to demonstrate sound decision-making skills
What We Offer
- reputed company offered
- Equipment provided
- Paid training to set you up for success
- Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
- Paid Time Off (PTO)
- 7 paid holidays
- A supportive team and a company that values internal growth
Ready to Grow Your Career? We’d love to meet you! Click “Apply Now” and tell us why you’d be a great addition to the reputed company team. About reputed company reputed company is a leading provider of back-office support reputed company and tech-enabled reputed company services to healthcare plans nationwide. reputed company provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers. The company currently serves over 70 reputed company, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow reputed company platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients. reputed company is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines. Work Location: Remote Apply To reputed company Job Apply To This Job