Foreign Claims Processor (Bargaining Unit role)

WPS Health Solutions New • Madison, WI

3d • Hybrid

About The Position

Process all MVH overseas claims from receipt through resolution in accordance with MVH regulations, guidelines, and quality standards, with expertise in coordination of benefits (COB), DEERS eligibility, and claims development. This role involves determining corrective action for various claim errors, translating, researching, and verifying claim information, selecting correct procedure and diagnosis codes using ICD-9, ICD-10, CPT4, and HCPCS manuals, obtaining development information from external contacts, and updating patient/sponsor files.

Requirements

• High School Diploma or GED or equivalent experience.
• U.S. citizenship is required for this position due to Department of Defense restrictions.
• One (1) or more years of experience in a claims processing role.
• Demonstrated proficiency in data entry with a strong ability to maintain focus and accuracy.
• Ability to effectively utilize available resources to further research and verify claims.
• Strong written communication skills.
• Demonstrates the ability to work independently and take initiative.
• Wired (ethernet cable) internet connection from your router to your computer.
• High speed cable or fiber Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection.

Nice To Haves

• Ability to translate a foreign language.
• Two (2) or more years of prior health insurance experience, i.e., Claims Processor, Customer Service Representative, or Billing Representative preferred.

Responsibilities

• Process all MH overseas claim types by determining corrective action to be taken on various types of errors pended by edit system and resolving interactive edits.
• Translate, research, and verify claims information to determine if all requirements have been met.
• Review submitted claim information and select correct procedure code and diagnosis code using ICD-9, ICD-10, CPT4, and HCPCS manuals.
• Obtain development information from external contacts and add successful development information to notepad via PC.
• Access patient/sponsor files and update information accordingly.

Benefits

• Performance bonus and/or merit increase opportunities
• 401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Employee Resource Groups
• Professional and Leadership Development Programs

What This Job Offers

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