Job Description

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