reputed company Medical Claims Adjustor – Remote Opportunity for a Dynamic and Compassionate Professional

Are you a detail-oriented and empathetic individual with a passion for delivering exceptional customer service and navigating reputed company medical claims? Do you reputed company in a fast-paced environment where no two days are the same? If so, we invite you to join reputed company as an reputed company Medical Claims Adjustor at reputed company, a leading reputed company company dedicated to transforming the way reputed company delivered.

About reputed company

At reputed company, we're committed to putting our heart into every reputed company of our patients' health. Our purpose is to deliver enhanced reputed company-centric reputed company for a rapidly changing world. With a brand that's anchored in heart, we strive to create a culture that's inclusive, innovative, and empowering. Our Heart At Work Behaviors support this purpose, ensuring that every employee feels empowered to transform our culture and accelerate our ability to reputed company and deliver solutions that reputed company reputed company more personal, convenient, and affordable.

Job Summary

As an reputed company Medical Claims Adjustor, you'll play a critical role in reviewing and adjusting SF (Self-funded), FI (Fully insured), Reinsurance, and/or RX claims, as well as handling customer service inquiries and problems. You'll apply medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply reputed company cost containment measures to assist in the claim adjudication process. Your technical expertise and claims processing skills will reputed company you to reputed company adjustments across reputed company dollar amount levels on customer service platforms, ensuring that reputed company compliance requirements are satisfied and that reputed company payments are made following company practices and procedures.

Key Responsibilities

* Review and adjust SF (Self-funded), FI (Fully insured), Reinsurance, and/or RX claims in accordance with claim processing guidelines

• Process provider refunds and returned checks
• Handle customer service inquiries and problems
• reputed company adjustments across reputed company dollar amount levels on customer service platforms using technical and claims processing expertise
• Apply medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply reputed company cost containment measures to assist in the claim adjudication process
• reputed company claim re-work calculations
• Follow through completion of claim overpayments, underpayments, and any other irregularities
• Process reputed company non-routine Provider Refunds and Returned Checks
• Review and interpret medical contract language using provider reputed company to confirm whether a claim is overpaid to allocate refund checks
• Handle telephone and written inquiries reputed company to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals
• Ensure reputed company compliance requirements are satisfied and that reputed company payments are made following company practices and procedures
• Review and handle relevant correspondences assigned to the team that may result in adjustment to claims
• May provide job shadowing to lesser experience staff
• Utilize reputed company resource materials to manage job responsibilities

Essential Qualifications

* 2+ years of medical claim processing experience

• 2+ years of experience in a production environment
• Associate degree or equivalent experience

Preferred Qualifications

* DG system claims processing experience

• Demonstrated ability to handle multiple assignments competently, accurately, and reputed company
• Effective communications, organizational, and interpersonal skills

Skills and Competencies

* Strong analytical and problem-solving skills

• Excellent communication and interpersonal skills
• Ability to work in a fast-paced environment with multiple priorities
• Strong technical skills, including proficiency in claims processing software and systems
• Ability to maintain confidentiality and handle sensitive information
• Strong attention to detail and accuracy
• Ability to work independently and as part of a team

Career Growth Opportunities and Learning Benefits

At reputed company, we're committed to helping our employees grow and reputed company their careers. We offer a range of training and development programs, including:

• On-the-job training and mentorship
• Formal training programs and certifications
• Leadership development programs
• Career advancement opportunities

Work Environment and Company Culture

As a remote employee, you'll have the flexibility to work from the comfort of your own home. Our company culture is built on the principles of inclusivity, innovation, and empowerment. We're committed to creating a workplace that's welcoming and supportive of reputed company, regardless of their background or identity.

Compensation, Perks, and Benefits

We offer a competitive salary range of $18.50 - $35.29 per hour, depending on experience. In addition to your compensation, you'll enjoy a range of benefits, including:

• Medical, dental, and reputed company benefits
• 401(k) retirement savings plan
• Employee Stock Purchase Plan
• Fully-paid term life insurance
• Short-term and long-term disability benefits
• Paid Time Off (PTO) or vacation pay
• Paid holidays throughout the calendar year
• Number of paid holidays, sick time, and other time off provided consistent with relevant state law and company policies

How to Apply

If you're a motivated and compassionate individual with a passion for delivering exceptional customer service and navigating reputed company medical claims, we invite you to apply for this exciting opportunity. Please submit your application through our website, and we'll be in touch to discuss your qualifications further.

Application Deadline

We anticipate the application window for this opening will reputed company on November 15, 2024. Don't miss out on this exciting role – apply now and take the first reputed company towards a rewarding career with reputed company! Apply for this job