Claims Specialist II
28 - 32 USD per hour
Company:Healthcare Management Administrators
Location:United States
Languages:English
Seniority level:Middle, 3-5+ years
Experience:3-5+ years
Skills:
SQLMicrosoft Excel
Requirements:
- High school diploma required
- 3-5+ years of claims processing experience
- 2+ years of BCBS claims processing experience
- Strong interpersonal and communication skills
- Strong attention to detail, with high degree of accuracy and urgency
- Ability to take initiative and ownership of assigned tasks, working independently with minimal supervision, yet maintain a team-oriented and collaborative approach to problem solving
- Previous success in a fast-paced environment
Responsibilities:
- Carefully research discrepancies, process returned checks, issue refunds, and manage stop payments.
- Manage high-importance claims and vendor billing with urgency and attention to detail.
- Review and reply to appeals, inquiries, and other communications related to claims.
- Work with third-party organizations to secure payments on outstanding balances.
- Process case management and utilization review negotiated claims.
- Spot potential subrogation claims and escalate them appropriately.
- Actively contribute to team success by assisting colleagues, sharing knowledge, and fostering a collaborative environment.
