Medical Claims Examiner Remote

reputed company is Hiring!

Medical Claims Examiner - Remote

Processing of Professional claim forms files by provider

Reviewing the policies and benefits

Comply with company regulations regarding HIPAA, confidentiality, and PHI

Abide with the timelines to complete compliance training of reputed company/Client

Work independently to research, review and act on the claims

Prioritize work and adjudicate claims as per turnaround time/SLAs

Ensure claims are adjudicated as per clients defined workflows, guidelines

Sustaining and meeting the client productivity/quality targets to avoid penalties

Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA.

Timely response and resolution of claims received via emails as priority work

Correctly calculate claims payable amount using applicable methodology/ fee schedule

Requirements:

1-3 year(s) hands-on experience in Healthcare Claims Processing, Claims Adjustments.

2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools

High school diploma or GED.

Previously performing in P&Q work environment; work from queue; remotely

Key board skills and computer familiarity

Toggling back and forth between screens/can you navigate multiple systems.

Working knowledge of MS office products Outlook, MS Word and MS-Excel.

Must be able to work 8 am - 4:30 pm EST online/remote (training is required on-camera).

Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities

Time management with the ability to cope in a complex, changing environment

Ability to communicate (oral/written) effectively in a professional office setting

High School Diploma

Preferred Skills & Experiences:

Amisys or Xcelys preferred.

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