Claims Examiner III - Health Insurance
About The Position
Job Description Role Purpose As a Claims Processor you'll be responsible for reviewing and processing insurance claims to determine the appropriate action to be taken. This role involves gathering information, evaluating claims for validity, and ensuring that all necessary documentation is complete. This position will require you to be in office for the first 8 weeks of training and then will go to remote, WFH. The office is located in the Tampa Bay, Fl area near the airport.
Requirements
- ICD-9 &10 Coding
- Customer Service
- Computer skills with knowledge of Outlook. Word & Excel
- Expert knowledge with a minimum experience of 3 years in Healthcare and claims processing.
- Experience in Govt. Ops with a experience of Medicare and Retirement / Medicaid claims processing.
- Able to explain the terms, Copay, Coinsurance, Deductible and out of pocket.
- Able to describe Medicaid and Medicare eligibility in detail.
- Experience in M&R / Medicaid Rework/Adjustment claims processing preferred.
- Excellent Communication Skills (Verbal & Written)
- CMS 1500 & UB Form Experience is a PLUS!
- Claims_Processing
Responsibilities
- Medical Claims Processing - Accurately review, verify and process insurance claims following the company policies/SOPs.
- Documentation Review - Analyze claim documents, medical records, benefit summary to determine claim eligibility and process the claim as per the benefit.
- Customer and Internal Business Partner Interaction - Communicate with member, healthcare providers and internal business partners to resolve the claim or gather required additional information.
- Data Entry - Enter claim details and maintain accurate records within the claims management system.
- Problem resolution - Investigate discrepancies and resolve disputes related claim processing
- Rework Adjustment Experience - Should be able to perform the rework adjustment basis the provider request and internal rework/adjustment requirement.
Benefits
- Wipro's standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Professional, Scientific, and Technical Services
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
