Job Summary
Join our dynamic team as a Claims Specialist where you will leverage your expertise in claims adjudication to enhance our healthcare operations. With a focus on accuracy and efficiency you will play a crucial role in processing claims ensuring compliance and improving customer satisfaction. This work-from-home position offers a day shift schedule allowing for a balanced work-life experience.
Responsibilities
- Process healthcare claims with precision ensuring all adjudication procedures are followed accurately.
- Analyze claims data to identify discrepancies and implement corrective measures to enhance processing efficiency.
- Collaborate with cross-functional teams to streamline claims operations and improve overall service delivery.
- Utilize your expertise in claims adjudication to provide insights and recommendations for process improvements.
- Ensure compliance with industry regulations and company policies while processing claims.
- Maintain detailed records of claims processed ensuring data integrity and confidentiality.
- Respond to inquiries from stakeholders regarding claims status and resolution.
- Utilize domain knowledge in claims and payer processes to enhance adjudication accuracy.
- Provide training and support to junior team members fostering a collaborative work environment.
- Monitor and report on key performance indicators related to claims processing.
- Engage in continuous learning to stay updated with industry trends and best practices.
- Contribute to the development of innovative solutions to improve claims adjudication processes.
- Support the companys mission to deliver exceptional healthcare services through efficient claims management.
Qualifications
- Possess a minimum of 3 years of experience in claims adjudication demonstrating a strong understanding of the process.
- Experience in the healthcare domain particularly in claims and payer processes is highly desirable.
- Strong analytical skills with the ability to identify and resolve discrepancies in claims data.
- Excellent communication skills to effectively collaborate with team members and stakeholders.
- Ability to work independently in a remote setting demonstrating self-motivation and discipline.
- Proficiency in using claims processing software and tools.
- Commitment to maintaining confidentiality and data integrity in all aspects of work.
Certifications Required
BSC Nursing with min 2-3 years if Clinical experience
