Claims Specialist I - VA Only
About The Position
Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! Modivcare is looking for a Claims Specialist I to join our team. This position is responsible for processing and managing claims submitted by providers, including verifying the accuracy and completeness of documentation and attachments. This role… Reviews incoming claims and related documentation to ensure accuracy and completeness. Inputs claim data and pertinent information into the claims processing system. Reviews company policies to determine coverage and assess the validity of claims. Uses standard scripts or form letters to request missing information. Applies established guidelines and policies to determine claim eligibility and process accordingly. Communicates with providers when necessary to obtain additional information or clarify claim details. Adheres to departmental policies, deadlines, and procedures for claim handling. Reports suspected fraudulent claims to the Fraud, Waste, and Abuse (FWA) department. May participate in special projects or perform other duties as assigned. We are interested in speaking with individuals with the following…
Requirements
- High School Diploma required.
- Zero (0) plus years of experience. Or equivalent combination of education and/or experience.
- Strong attention to detail and data entry skills to ensure claim accuracy.
- Basic computer proficiency, including Microsoft Word, Excel, and Outlook.
- Analytical mindset with the ability to interpret claim data and follow established procedures.
- Effective verbal and written communication skills with a superior customer-focused demeanor.
- Problem-solving skills to address claim discrepancies and issues.
- Ability to work both independently and as part of a collaborative team.
Responsibilities
- Reviews incoming claims and related documentation to ensure accuracy and completeness.
- Inputs claim data and pertinent information into the claims processing system.
- Reviews company policies to determine coverage and assess the validity of claims.
- Uses standard scripts or form letters to request missing information.
- Applies established guidelines and policies to determine claim eligibility and process accordingly.
- Communicates with providers when necessary to obtain additional information or clarify claim details.
- Adheres to departmental policies, deadlines, and procedures for claim handling.
- Reports suspected fraudulent claims to the Fraud, Waste, and Abuse (FWA) department.
- May participate in special projects or perform other duties as assigned.
Benefits
- Medical, Dental, and Vision insurance
- Employer Paid Basic Life Insurance and AD&D
- Voluntary Life Insurance (Employee/Spouse/Child)
- Health Care and Dependent Care Flexible Spending Accounts
- Pre-Tax and Post --Tax Commuter and Parking Benefits
- 401(k) Retirement Savings Plan with Company Match
- Paid Time Off
- Paid Parental Leave
- Short-Term and Long-Term Disability
- Tuition Reimbursement
- Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
