Health Claims Specialists

This is a full-time permanent healthcare claims adjudicator position. A claims adjudicator determines how much money will be paid after an insurance claim has been examined. This is not a customer service or customer facing position. This is a data entry position where you will be processing medical claims per the specific client requirements. Claims can vary and are highly customized depending on the service level. You will work independently with the assistance of knowledge base and support personnel. You will also be expected to meet all Key Performance Indicators and Quality goals throughout Training and beyond.

Responsibilities

Work independently, processing claims via data entry for 90% of your day; Adjudicate claims to meet production, quality, and other metrics in accordance with policy/procedures and regulatory guidelines; Follow up on claims needing additional information; Refer problem claims to a Lead and/or auditor for additional review; Ensure the integrity of information is accurate and kept private according to HIPAA guidelines; Work with specific software; May be assigned special projects; Meet all Key Performance Indicators and Quality goals throughout Training and beyond

Requirements

High School Diploma or equivalent; Internet access speed of 2 Mbps upload and 10 Mbps download; Hard-wired internet connection (wireless and satellite connections not compatible); A quiet, distraction-free, secure place to work; Effective verbal and written communication skills; Strong typing and analytical abilities; Multi-tasking skills with strong attention to detail; Computer knowledge; Minimum 40 words per minute on typing test; Clean, paper-free work environment; Medical Billing and Coding degree/certification; Previous experience in a medical office type setting, including some knowledge of insurance, claims, billing or coding, and understanding of different types of insurance (Medicare/Medicaid and/or Child Plus); Knowledge of medical terminology; Data entry; Time management; Attention to detail; Analytical skills

Benefits

Pay rate of $13.50/hour with opportunity to bonus an additional $1500 a month; Medical, dental, and vision plans; Paid training and PTO; Global Flexible Vacation Policy; Company-provided equipment; Advancement opportunities; Monthly rewards & recognition programs; Employee discounts; EAP and Health and Wellness programs including a personal trainer dedicated to Sutherland