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Claims Specialist

Posted about 1 month agoViewed

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💎 Seniority level: Senior, 10+ years

📍 Location: United States

💸 Salary: 100000.0 - 125000.0 USD per year

🔍 Industry: Insurance

🏢 Company: Next Insurance👥 501-1000💰 $265,000,000 Series F over 1 year ago🫂 Last layoff almost 3 years agoFinanceInsurTechInsuranceSmall and Medium BusinessesCommercial Insurance

🗣️ Languages: English

⏳ Experience: 10+ years

🪄 Skills: SQLOracleCommunication SkillsAnalytical SkillsProblem SolvingNegotiationWritten communicationComplianceInterpersonal skillsTeamworkRisk Management

Requirements:
  • BS/BA Degree required
  • At least 10+ years of directly related experience with Commercial General Liability and Litigation
  • Strong written and oral communication skills required, as well as strong interpersonal, analytical, investigative, and negotiation skills
  • In-depth knowledge of multi-jurisdictional claims handling issues
  • Candidates must have, or be able to promptly obtain, a Texas Independent Adjuster License
Responsibilities:
  • Extensive policy document and legal contract interpretation
  • Manage, investigate, and resolve claims within prescribed authority levels
  • Communicate with policyholders, witnesses, and claimants in order to gather information regarding claims, refer tasks to auxiliary resources as necessary, and advise as to the proper course of action
  • Comply with all statutory and regulatory requirements of all applicable jurisdiction
  • Set and revise case reserves in accordance with the reserving policy
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🔥 Claims Specialist - Remote
Posted about 1 month ago

📍 United States

💸 49920.0 - 58240.0 USD per year

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🏢 Company: Rising Medical Solutions👥 251-500MedicalHealth Care

  • High school diploma required; Associate’s or Bachelor’s degree preferred
  • CPC (Certified Professional Coder), CCS (Certified Coding Specialist) or equivalent medical coding certification preferred
  • 2-4 years of insurance or healthcare experience, preferably in claims or medical billing-related position(s)
  • Knowledge of Group Health Insurance, Workers' Compensation, No-Fault, and/or Liability industry
  • Strong knowledge of medical terminology, CPT and ICD coding, and healthcare billing practices
  • Well-developed time-management, organization, and prioritization skills
  • Excellent analytical skills
  • Customer-service orientation
  • Excellent oral and written communication skills
  • Knowledge of medical billing procedures
  • Ability to gather data, compile information, and prepare summary reports
  • Strong interpersonal and conflict resolutions skills
  • Ability to work independently and as part of a team a fast-paced, multi-faceted environment
  • Demonstrated persistence and attention to detail
  • Maintain ongoing knowledge of program requirements
  • Analyze and process claims for accuracy, eligibility, and benefits coverage
  • Retain and strengthen relationships with clients and members
  • Assist members in managing and resolving reimbursement issues related to medical services and covered expenses that are medically necessary
  • Correspond to verify if the amounts are related to the claim
  • Develop and maintain a working knowledge of medical bill processing, procedures, and supporting systems
  • Adhere to quality assurance objectives and goals
  • Develop and maintain a working knowledge of all support systems to ensure ever increasing client value and Rising’s returns from administration services
  • Research and utilize problem-solving skills to resolve claim discrepancies, errors, or incomplete information by communicating with providers, members, or internal departments
  • Keep management updated on activities, issues and developments
  • Document all claims decisions and communications with members in the system accurately and timely
  • Ensure strict confidentiality of all medical information and adhere to privacy regulations and company policies
  • Special projects as assigned by management

Analytical SkillsProblem SolvingCustomer serviceAttention to detailOrganizational skillsTime ManagementWritten communicationInterpersonal skillsVerbal communicationData entry

Posted about 1 month ago
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