Claims Specialist

MotivHealth Insurance Company • South Jordan, UT

4d

About The Position

In this role, you will serve as the claim expert, performing non-standard, advanced and complicated claim processes. Claim Specialists perform in-depth investigations regarding complex claim issues. Additionally, the Claim Specialists identify problems and issues related to our tools and processes, to improve. This includes working with external parties to ensure the quality and accuracy of complex claim adjudication. Additionally, you will be expected to help advance and grow MotivHealth’s Claim Services department.

Requirements

• At least 6 months experience working as a Claims Processor, consistently meeting quality and volume standards required
• Mastery of all types of claim processes
• Medical terminology, CPT, ICD and Revenue Coding expertise
• Desire to grow and learn new skills
• Respected and trusted by peers and leaders
• Excellent interpersonal skills, desire to help others, strong communicators with internal and external parties who have varying knowledge and background, including translating complicated concepts, ensuring understanding and building trust
• Proven team player who contributes to building high performing teams
• Self-starter who takes initiative, enjoys investigating and solving challenging problems, sees things through to completion and is highly accountable
• Clear and confident communication, both written and verbal
• Innovator with a strong desire to challenge existing norms related to traditional healthcare and health insurance

Responsibilities

• Load, review and adjudicate complex claims submitted by providers and members electronically and by paper
• Manage and perform adjustments, reconsiderations and other advanced claim processes
• Consistently exceed processing accuracy and volume standards where appropriate
• Research and resolve complicated claims, quality concerns, and other member or provider issues
• Participation with external parties regarding Subrogation, Other Payer Liability, High Dollar Claims, Stop Loss and the like
• Serve as the point of contact for Claim Processors and Personal Health Assistants claim questions and issues
• Identify and explore trends, patterns and issues that require tool or process changes
• Maintain compliance, privacy and confidentiality in all documentation, communications and correspondence
• Contribute to team wide goals to improve claims processes and integrate additional functions into our operations

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed