Senior Claim Benefit Specialist

Description:

• reviews, researches and adjudicates complex, sensitive, and/or specialized encounters in accordance with State driven encounter processing guidelines.
• May be required to learn multiple Medicaid plans.
• Works to research and resolve encounter errors
• Ensures all compliance requirements are met.
• Identifies and reports possible claim overpayments, underpayments, scanning issues and any other irregularities.

Requirements:

• 2 years Medical Claims processing experience adjudicating claims (Commercial, Medicaid, Medicare, etc.)
• Experience in a production environment.
• Analytical skills, with the ability to research particularly in areas involving rejected claims.
• Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
• Demonstrated proficiency with personal computer, keyboard navigation skills, and MS Office Suite applications.
• Preferred Qualifications QNXT claims processing experience
• Encounters experience
• Edifecs knowledge.

Benefits:

• Affordable medical plan options
• a 401(k) plan (including matching company contributions)
• an employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings
• tobacco cessation and weight management programs
• confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off
• flexible work schedules
• family leave
• dependent care resources
• colleague assistance programs
• tuition assistance
• retiree medical access and many other benefits depending on eligibility.

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