Claims Review Representative 3 - Remote

Overview

Become a part of our caring community and help us put health first. The Claims Review Representative 3 makes appropriate claim decisions based on strong knowledge of claims procedures, contract provisions, and state and federal legislation.

In Short

• Make appropriate claim decisions based on knowledge of claims procedures.
• Perform advanced administrative/operational/customer support duties.
• Partner with professional staff on pre-screening reviews.
• Exercise discretion and judgment in prioritizing requests.
• Manage and prioritize tasks based on business needs.
• Work in a remote environment with occasional travel for training.
• Utilize Microsoft Office applications effectively.
• Ensure compliance with Medicaid regulations.
• Receive benefits starting from day 1 of employment.
• Participate in professional development opportunities.

Requirements

• Minimum of 1 year of experience with processing and adjudicating medical claims.
• Knowledge of CPT, ICD9, and ICD10 terminology/codes.
• Proficiency in Microsoft Office applications including Word, Excel, and Outlook.
• Ability to quickly learn new systems.
• Must reside stateside per Medicaid regulations.
• Preferred qualifications include CAS and/or CRM experience.
• Finance knowledge is a plus.

Benefits

• Competitive 401k match.
• Generous Paid Time Off accrual.
• Tuition Reimbursement.
• Parent Leave.
• Comprehensive medical, dental, and vision benefits.