Welcome to Jobfind4u.anekjob.com We provide job seekers with information gathered from various publicly available job posting websites, including but not limited to Google, Indeed, LinkedIn, and other well-known job platforms. Our mission is to help individuals find employment opportunities by offering up-to-date job listings and career-related resources. We do not charge any fees for accessing or using our website, and all job information is provided free of charge.
Jobfind4u.anekjob.com does not directly offer, manage, or engage in the hiring process for any of the job listings featured on our website. All listings are sourced from third-party job posting platforms such as Indeed, LinkedIn, and other recognized job websites.
By using our website, you acknowledge and accept the above terms and conditions. Thank you for visiting Jobfind4u.anekjob.com, and we wish you success in your job search.
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.
Role Description
Performs claim documentation review, verifies policy coverage, assesses claim validity, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills.
Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines.
Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope.
Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements.
Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims.
Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution.
Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims.
Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies.
Develops and implements regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.
Analyzes claims data and generates reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department.
Qualifications
1-2 years’ experience working in Customer Service.
Possess strong teamwork and organizational skills.
Strong and effective communication skills.
Ability to handle multiple assignments competently through use of time management, accurately and efficiently.
Strong proficiency using computers and experience with data entry.
Requirements
Experience in a production environment.
Healthcare experience.
Knowledge of utilizing multiple systems at once to resolve complex issues.
Claim processing experience preferred but not required.
Understanding of medical terminology.
Benefits
Affordable medical plan options.
401(k) plan (including matching company contributions).
Employee stock purchase plan.
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
