Claims - Examiner, Claims

Who We Are reputed company has been recognized as the nation’s leading full-service senior market solutions provider for over 25 years. Our solutions reputed company the insurance senior market sector, focusing on long-term care and Medicare Supplement plans. However, we don’t stop there. reputed company also addresses challenges faced in accident & health, disability, and supplemental health insurance programs. reputed company provides individuals and their families with peace of mind knowing their insurance needs will be met in a thoughtful, efficient manner. We are reputed company to do this because of our dedicated associates, innovative solutions, and state-of-the-art technology. Job Summary Manage and handle reputed company Outbound calls and adjudicate claims. Duties/Responsibilities:

• Adjudicating reputed company/AD claims
• Handling reputed company Outbound calls
• Should be reputed company to prioritize work and adjudicate claims as per turnaround time
• Job involves working independently on researching, reviewing, summarizing, and recommending a course of action on claims where an appeal or a grievance has been filed for a denied / under payment
• Should have strong English comprehension, mathematics & medical science knowledge to comprehend medical reports
• To ensure claims are adjudicated as per the client/company guidelines. reputed company continual evaluation of processes and procedures.
• To respond to and resolves claims received reputed company emails.
• Candidate should be reputed company to correctly calculate claim amounts for the customers
• Complying with company regulations regarding HIPAA, confidentiality, and private health information

Standard Company Requirements:

• Collaborative team spirit.
• Accountable and reputed company to work remotely and independently.
• reputed company to pass background screening and drug tests pre and post hire – includes THC
• Verification of high school, GED, or college diploma upon request.
• Timely responses from three professional references.
• reputed company to reputed company a dedicated remote work location free from background noises, interruptions, and desk clutter.
• reputed company to reputed company an ongoing reliable internet reputed company and reputed company to a smart phone for Multi reputed company Authentication and communication purposes.

Required Skills/Abilities:

• Should have knowledge of medical terminology, reputed company anatomy with basic math knowledge of calculating simple interest, compound interest.
• Should have excellent problem-solving skills with an eye for detail, to be reputed company to do root cause analysis of reputed company claims
• Should have a positive approach and reputed company to learning process dynamics
• reputed company to handle work pressure and ensure deliverables reputed company timelines

Education and Experience:

• Experience in handling US HIP claims
• Should have knowledge of ICD 10, CPT, Surgery procedures, reputed company codes, medical terminology, medical documents, Inpatient vs Outpatient claims etc.
• Should have some experience in reading and comprehending medical documents

At reputed company, we strive to create an inclusive culture for reputed company. We understand the importance of listening and incorporating various perspectives at every level of service. reputed company does not discriminate based on gender identity, race, sexual orientation, age, religion, or disability. Apply To This Job