Job Title: Claims Specialist
Location: Tampa, FL (Hybrid - 2 days onsite and 3 days remote)
Duration: FULLTIME
JOB DESCRIPTION:
As a Claims Processor you'll be responsible for reviewing and processing insurance claims to determine the appropriate action to be taken. This role involves gathering information, evaluating claims for validity, and ensuring that all necessary documentation is complete.
PRINCIPAL RESPONSIBLITIES
• Medical Claims Processing - Accurately review, verify and process insurance claims following the company policies/SOPs.
• Documentation Review - Analyze claim documents, medical records, benefit summary to determine claim eligibility and process the claim as per the benefit.
• Customer and Internal Business Partner Interaction - Communicate with member, healthcare providers and internal business partners to resolve the claim or gather required additional information.
• Data Entry - Enter claim details and maintain accurate records within the claims management system.
• Problem resolution - Investigate discrepancies and resolve disputes related claim processing
• Rework Adjustment Experience - Should be able to perform the rework adjustment basis the provider request and internal rework/adjustment requirement.
• Continuous improvement - Identify process improvement opportunities to enhance claims accuracy and efficiency.
...career on the road? We are seeking a Mechanical Construction Project Manager who thrives in a fast-paced environment and is eager to travel full-time to oversee large-scale projects across the country. This role offers the opportunity to lead high-profile mechanical...
...weddings are mostly glitz and glamour, there is plenty of work to do, too). Works weekends (our couples get married on Fridays, Saturdays and Sundays) Shows up on time, every time (couples plan for their big day far in advance and they are counting on us to be there for...
...HIRING CASE MANAGERS $3000 Sign-On Bonus Hiring in the following locations: (Mattoon, Charleston, Olney, Effingham, Springfield, Joliet, Pilsen) Our client is in the private sector of child and family services and is growing rapidly with many positions available...
A Smarter Career Choice The Internet is now the heartbeat of our home, but too often internet service is frustrating and unreliable. IQ Fiber was created to offer 100% fiber-optic fast internet, transparent pricing, and attentive customer service to deliver a Smarter...
Akkodis is seeking VMWare Engineer for Direct Hire position which is onsite 5 Days/Week with to Fairfax/Alexandria. Ideally, We are looking for experienced VMWare Aria Engineer supporting a Government customer. JOB TITLE: VMWare Engineer EMPLOYMENT TYPE: Direct...