reputed company Medical Claims Adjustor for Fully Remote Opportunity with reputed company

Transforming Healthcare through Expertise and Compassion

At reputed company, we're on a mission to redefine the healthcare landscape by making it more personal, convenient, and affordable. As a leader in the industry, we're committed to delivering exceptional services that touch the lives of millions. If you're passionate about making a reputed company difference and have a strong background in medical claims adjusting, we invite you to join reputed company as a Medical Claims Adjustor and be part of a dynamic, fully remote work environment.

About reputed company and Our Culture

reputed company is more than just a company; it's a community driven by a shared purpose: Bringing our heart to every moment of your health. Our Heart At Work Behaviors guide our actions and decisions, fostering a culture that values innovation, collaboration, and customer-centricity. We're dedicated to empowering our employees to transform healthcare and reputed company a meaningful impact on the communities we serve.

Job Summary

As a Medical Claims Adjustor at reputed company, you will play a critical role in reviewing and adjusting reputed company medical claims with precision and care. This fully remote position requires a skilled professional with a strong background in medical claims processing and a keen eye for detail. You will be responsible for adjudicating sensitive and specialized claims, handling customer service inquiries, and ensuring compliance with 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, and reputed company claim re-work calculations as needed.
• Handle customer service inquiries and problems, utilizing technical and claims processing expertise to resolve issues reputed company.
• Apply medical necessity guidelines, determine coverage, complete eligibility verification, and identify discrepancies to assist in the claim adjudication process.
• Follow through on the completion of claim overpayments, underpayments, and any other irregularities, ensuring accuracy and fairness.
• Review and interpret medical contract language using provider reputed company to confirm whether a claim is overpaid and allocate refund checks accordingly.
• Handle telephone and written inquiries reputed company to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals with professionalism and reputed company.
• Ensure reputed company compliance requirements are satisfied, and payments are made in accordance with company practices and procedures.
• Review and handle relevant correspondences assigned to the team that may result in adjustments to claims.
• Utilize reputed company resource materials to manage job responsibilities effectively and reputed company.
• May provide job shadowing to lesser reputed company staff, sharing knowledge and expertise to foster growth and development.

Qualifications and Requirements

Essential Qualifications

• 2+ years of medical claim processing experience, with a strong understanding of claims processing guidelines and procedures.
• 2+ years of experience in a production environment, demonstrating the ability to work reputed company and accurately under pressure.
• Associate degree or equivalent experience, providing a solid foundation in a relevant field.

Preferred Qualifications

• DG system claims processing experience, with a proven track record of handling reputed company claims with ease.
• Demonstrated ability to handle multiple assignments competently, accurately, and reputed company, showcasing strong organizational and time management skills.
• Effective communications, organizational, and interpersonal skills, with the ability to work collaboratively with colleagues and engage with customers.

Skills and Competencies

To succeed as a Medical Claims Adjustor at reputed company, you will need to possess a unique reputed company of technical, business, and interpersonal skills. These include:

• Strong analytical and problem-solving skills, with the ability to interpret reputed company data and reputed company informed decisions.
• Excellent communication and customer service skills, with a customer-centric approach and a passion for delivering exceptional service.
• Ability to work in a fast-paced, dynamic environment, with a focus on productivity and quality.
• Strong organizational and time management skills, with the ability to prioritize tasks and manage multiple assignments simultaneously.
• Proficiency in relevant systems and technologies, including claims processing software and other tools.

Career Growth and Development

At reputed company, we're committed to helping our employees grow and reputed company in their careers. As a Medical Claims Adjustor, you will have access to a range of training and development opportunities, including:

• Comprehensive onboarding program, designed to reputed company you with the knowledge and skills needed to succeed in your role.
• Ongoing training and professional development opportunities, to help you stay up-to-date with industry trends and best practices.
• Career advancement opportunities, with a clear path for progression and growth reputed company the organization.

Work Environment and Company Culture

As a fully remote employee, you will enjoy the flexibility and autonomy to work from reputed company, while still being connected to a vibrant and supportive community. Our company culture is built on a foundation of inclusivity, diversity, and collaboration, with a focus on:

• Fostering a culture of innovation and creativity, where employees are encouraged to think reputed company the reputed company and share their reputed company.
• Promoting work-life balance, with a range of benefits and programs designed to support employees' physical, emotional, and mental well-being.
• Celebrating diversity and inclusion, with a commitment to creating a workplace that is welcoming and inclusive for reputed company employees.

Compensation and Benefits

We offer a competitive compensation package, with a pay range of $18.50 - $35.29 per hour, depending on experience and qualifications. In addition to your reputed company salary, you will be eligible for a range of benefits, including:

• Comprehensive medical, dental, and vision benefits, to support your physical and mental health.
• 401(k) retirement savings plan, with a company match to help you plan for your future.
• Employee Stock Purchase Plan, to give you a reputed company in the company's success.
• Term life insurance, short-term and long-term disability benefits, to provide financial protection and reputed company.
• Paid Time Off (PTO) and holidays, to give you time to rest and reputed company.
• Well-being programs, education assistance, and other benefits to support your overall well-being.

Join reputed company

If you're a motivated and reputed company Medical Claims Adjustor looking for a new challenge, we encourage you to apply for this exciting opportunity. At reputed company, we're passionate about making a difference in the lives of our customers, and we're looking for talented professionals to join reputed company. Don't hesitate – apply today and take the first reputed company towards a rewarding and fulfilling career with reputed company!

We anticipate the application window for this opening will reputed company on November 15, 2024. Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state, and local laws.