Claims - Claims Examiner

Wellcove • PENSACOLA, FL

18h

About The Position

Manage and handle all Outbound calls and adjudicate claims. Duties/Responsibilities: Adjudicating HP/AD claims Handling all Outbound calls Should be able to prioritize work and adjudicate claims as per turnaround time Job involves working independently on researching, reviewing, summarizing, and recommending a course of action on claims where an appeal or a grievance has been filed for a denied / under payment Should have strong English comprehension, mathematics & medical science knowledge to comprehend medical reports To ensure claims are adjudicated as per the client/company guidelines. Provide continual evaluation of processes and procedures. To respond to and resolves claims received via emails. Candidate should be able to correctly calculate claim amounts for the customers Complying with company regulations regarding HIPAA, confidentiality, and private health information

Requirements

• Should have knowledge of medical terminology, human anatomy with basic math knowledge of calculating simple interest, compound interest.
• Should have excellent problem-solving skills with an eye for detail, to be able to do root cause analysis of complex claims
• Should have a positive approach and open to learning process dynamics
• Ready to handle work pressure and ensure deliverables within timelines
• Experience in handling US HIP claims
• Should have knowledge of ICD 10, CPT, Surgery procedures, Revenue codes, medical terminology, medical documents, Inpatient vs Outpatient claims etc.
• Should have some experience in reading and comprehending medical documents
• Collaborative team spirit.
• Accountable and able to work remotely and independently.
• Able to pass background screening and drug tests pre and post hire – includes THC
• Verification of high school, GED, or college diploma upon request.
• Timely responses from three professional references.
• Able to provide a dedicated remote work location free from background noises, interruptions, and desk clutter.
• Able to provide an ongoing reliable internet connection and access to a smart phone for Multi Factor Authentication and communication purposes.

Responsibilities

• Adjudicating HP/AD claims
• Handling all Outbound calls
• Prioritize work and adjudicate claims as per turnaround time
• Researching, reviewing, summarizing, and recommending a course of action on claims where an appeal or a grievance has been filed for a denied / under payment
• Ensure claims are adjudicated as per the client/company guidelines
• Provide continual evaluation of processes and procedures
• Respond to and resolves claims received via emails
• Correctly calculate claim amounts for the customers
• Complying with company regulations regarding HIPAA, confidentiality, and private health information

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED