Claims Intake Specialist II - Fully Remote - Full Time!

SKYGEN•United States,

3d•$19 - $28•Remote

About The Position

The Claims Intake Specialist II ensures departmental tasks are completed to meet client turnaround times for claim payment and authorization determinations. This role manages special-handling requests to support internal and external requirements and works to ensure accurate, timely completion of client work. The specialist manages daily work distribution and queues, supports data entry processors, handles specialized workflows, researches and resolves submission issues, and communicates work readiness and potential issues to relevant teams and management. The position also processes primary insurance carriers’ EOBs, supports urgent operating-room authorization requests, validates provider credentials using outside databases, serves as a subject matter expert for Claims Intake matters, and assists with team training and special projects. This is a fully remote, full-time opportunity. The regular schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m. CST. Friday coverage includes a rotational 7:00 p.m. to 8:00 p.m. shift. There is potential to flex the schedule. Candidates must pass a pre-employment online alphanumeric data-entry assessment with a minimum score of 7,000 KSPH and 98% accuracy.

Requirements

High school diploma or equivalent.
At least 1 year of related experience, such as claim processing, dental assisting, dental front-office administration, health or dental insurance, managed care operations, accounts receivable, or a billing environment.
Pass a pre-employment online alphanumeric data-entry assessment with a minimum score of 7,000 KSPH and 98% accuracy.
Ability to work effectively with multiple interruptions.
Ability to organize work to meet deadlines.
Excellent attention to detail.
Ability to multitask.
Ability to use resources to solve problems independently.
Excellent critical-thinking skills.
Excellent verbal and written communication skills.
Basic knowledge of Microsoft applications.
Knowledge of insurance EOBs and billing codes.
Knowledge of American Dental Association (ADA) forms, UB-04 Facility Claim forms, or Member Reimbursement forms.

Nice To Haves

Bachelor’s degree in a related field.
At least 2 years of medical, dental, or vision claim-processing experience.

Responsibilities

Manage the daily work plan and distribute work to the team to meet client turnaround times.
Provide second-tier support and direction to data entry processors on resolving submission discrepancies according to client business rules.
Manage specialized workflows that deviate from standard processes and coordinate resolution with relevant departments.
Review reporting, ensure work queues are completed, and resolve open issues before claim payment and authorization review; communicate readiness to transfer data to appropriate departments.
Proactively communicate potential issues to management for timely resolution.
Use multiple Enterprise System modules to retrieve and research information and process submission or special-handling requests.
Apply client processing guidelines and requirements.
Process primary insurance carriers’ EOBs for appropriate payment.
Serve as a subject matter expert for Claims Intake items, answer questions from internal and external contacts, and resolve matters outside established workflows.
Identify provider submission errors and collaborate with internal teams on provider outreach and education.
Manage and process urgent operating-room authorization requests received by fax and coordinate with the authorization team to support timely review and determination.
Resolve electronically submitted provider data discrepancies that prevent processing, using outside databases to validate provider credentials.
Assist with training internal team members.
Partner with the Claims Intake team on other tasks needed to meet client service-level agreements accurately and on time.
Assist with special projects assigned by leadership.