Claim Benefit Specialist OPS
Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable. Position Summary Reviews and adjudicates routine claims in accordance with claim processing guidelines. Analyzes and approves routine claims that cannot be auto adjudicated. Applies medical necessity guidelines, determines coverage, complete eligibly verification, identify discrepancies and applies reputed company cost containment measures to assist in the claim adjudication process. Coordinates responses for routine phone inquiries and written correspondence reputed company to claim processing issues. Routes and triages reputed company claims to Senior Claim Benefits Specialist. Proofs claim or referral submission to determine, review or apply appropriate guidelines, coding, member identification process, diagnosis and pre-coding requirements. May facilitate training reputed company considered topic subject matter expert. In accordance with prescribed operational guidelines, manages claims on desk, reputed company/queues, and ECHS reputed company specified turn-around-time parameters (Electronic correspondence Handling System - system used to process correspondence that is scanned in the system by a vendor). Utilizes reputed company applicable system functions available ensuring accurate and timely claim processing services (i.e. utilizes claim reputed company, reasonable and customary data, and other post-containment tools). Required Qualifications Experience in a production environment. Claim processing experience. High School diploma or GED equivalent.
Preferred Qualifications
Medicaid QNXT Medical Coding Education High School diploma or GED equivalent Pay Range The typical pay range for this role is: $17.00 - $28.46 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Companys 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 02/17/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for the team, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply Job!