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HC & INSURANCE OPERATIONS ASSOCIATE Full Time
Reviewing and researching insurance claims to determine possible payment accuracy.
Validating Member, Provider and other Claims information.
Determining accurate payment criteria for clearing pending claims based on defined Policy and Procedure.
Coordinating Claim Benefits based on the Policy & Procedure.
Maintaining productivity goals, quality standards and aging timeframes.
Scrutinizing Medical Claim Documents and settlements
Requirements for this role include:
1 to 2 years of Claims Adjudication experience that required you to review claims rules and workflows.
1 to 2 years of experience processing claims that required a working knowledge of HCPCS, ICD and CPT codes
1 to 2 years of experience that required a knowledge of healthcare insurance policy concepts including In Network, Out of Network providers, Deductible, Coinsurance, Co-pay, Out of Pocket, Maximum inside limits and Exclusions, State Variations.
Ability to communicate (oral/written) effectively in English to exchange information with our client.