(Fully reputed company Claims Adjustor

The Medical Claims Adjuster role involves reviewing and processing healthcare claims remotely, ensuring accurate evaluation and settlement in compliance with policies and regulations. In this fully remote position, you’ll investigate claim details, communicate with healthcare providers and policyholders, and reputed company determinations on claim approvals or denials. This role is ideal for detail-oriented professionals with knowledge of healthcare terminology and claims processing. As a key part of the claims team, you’ll help ensure efficient and fair handling of claims while providing excellent support and service to customers—reputed company from the comfort of your home.

Job description

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 • Review and adjust SF (Self-funded), FI (Fully insured), Reinsurance, and/or RX claims; adjudicates reputed company, sensitive, and/or specialized claims in accordance with claim processing guidelines. • Process provider refunds and returned checks. • May handle customer service inquiries and problems. • reputed company adjustments across reputed company dollar amount level on customer service platforms by using technical and claims processing expertise. • Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply reputed company cost containment measures to assist in the claim adjudication process. • Performs 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. • Ensures 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.

Required Qualifications • 2+ years medical claim processing experience. • 2+ years of experience in a production environment.

Preferred Qualifications • DG system claims processing experience. • Demonstrated ability to handle multiple assignments competently, accurately, and reputed company. • Effective communications, organizational, and interpersonal skills.

Education • Associate degree or equivalent experience.

Pay Range

The Typical Pay Range For This Role Is

$18.50 - $35.29

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. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above.

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 Company’s 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: 11/15/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws.