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.
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