Senior Provider Payment Professional - Remote

Overview

Become a part of our caring community and help us put health first. The Senior Payment Integrity Professional uses technology and data mining to detect anomalies in data, identify and collect overpayment of claims, and contribute to investigations of fraud and waste.

In Short

• Work remotely while contributing to health payment integrity.
• Analyze complex data to improve claims payment accuracy.
• Make decisions on technical approaches for project components.
• Support fraud waste investigations.
• Work independently with considerable latitude in determining objectives.
• Engage in occasional travel for training or meetings.
• Full-time position with typical hours Monday-Friday.
• Competitive salary and bonus incentive plan available.
• Comprehensive benefits package including medical, dental, and vision.
• Focus on continuous improvement of consumer experiences.

Requirements

• Three or more years of experience in claims interpretation.
• Familiarity with Medicaid contracts and claims processes.
• Strong data analysis skills.
• Comprehensive knowledge of Microsoft Office programs.
• Excellent communication skills, both written and verbal.
• Ability to manage multiple priorities.
• Capacity to maintain confidentiality.
• Passion for contributing to organizational improvement.
• Bachelor's degree preferred.
• Bilingual in Spanish and English is a plus.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off and holidays.
• Short-term and long-term disability insurance.
• Life insurance and additional opportunities.
• Support for personal wellness and smart healthcare decisions.
• Work from a dedicated space to protect member information.
• Internet expense reimbursement for specific states.
• Access to advanced interviewing technology.
• Equal opportunity employer commitment.