Title:  Claims Specialist 3

Location: Remote 

Company: Healthcare

Length: Open-ended contract

100% remote (Work from home)

• Business is CST but opens to other time zones if they can work CST.
• ensure the candidates understand COB (Coordination of benefits), verify benefits/eligibility, and can work in a high production-based environment.

Description:

• The main function of the claims specialist is to analyze claim denials, work with payors to resolve denials, track all denials by payor and denial category, trend recurring denials, and recommend process improvement or system edits to eliminate future denials. 

Position Description 

• Coordination of Benefits Analysts is responsible for using established methods to investigate, verify, and record third-party liability (TPL) coverage information on behalf of our Medicaid payer clients.
• COB analysts research TPL coverage leads through various methods including phone calls, correspondence, and online portals. COB Analysts maintain accurate TPL coverage to trigger appropriate cost-avoidance and recovery activities.
• COB analysts also respond to client research requests and may be assigned other tasks as requested by management. C
• OB analysts operate in a fast-paced, production environment and take ownership of their work product by understanding the value of timely, accurate TPL lead investigation.

Responsibilities: 

• Ability to adapt to the significant and frequent changes in the healthcare market
• Ability to work within a team environment with a positive attitude
• Detail-oriented with strong investigative skills
• Ability to think critically and analytically regarding trends and patterns in data
• Proficiency in time and workload management with the ability to multi-task
• Able to efficiently make a medium volume of outbound calls to various insurance carriers
• Very strong verbal and written communication skills
• Proficiency in MS Windows and Office products (esp. Word and Excel)
• Overtime may be needed based on operational need

Minimum Requirements (Required): 

• 2-5 years of relevant healthcare experience or equivalent work experience
• Background in government and/or commercial insurance healthcare coverage is a plus
• Excellent Communication (Verbal & Written) Skills
• Strong work ethics and confidentiality
• Must successfully pass background check

Industry Skills (Preferred): 

• 2+ years of experience working with state and federal programs (Social Security & Medicaid)
• Medical Terminology & documentation experience is a plus
• Minimum of 1 year of demonstrated experience working with people of various educational and socioeconomic backgrounds (Government agency, Behavioral Health Facility,)
• Proficient computer skills with tablet devices and MS Office applications (Outlook, Intermediate Excel, and PowerPoint)

Education 

• Bachelor’s degree or relevant work experience with health insurance eligibility verification

Physical Requirements 

• General Office Demands