Remote Claims Specialist
About the Role
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JOB DESCRIPTION
- Process, adjust or update various moderate to complex claims payments and payment errors for any business segment and/or claims-provider type
- Respond promptly and accurately to inquiries from Customer Service Professionals, subscribers, providers, physicians and other insurance carriers regarding claims payments.
- Meet or exceed established quality and performance standards
- Determine suspended claim resolution methods by reviewing benefit eligibility, claims history and other information
- Escalate claims requiring specialized resolution to subject matter experts based on department policies and guidelines to ensure the resolution
- Understand business requirement for the customer and provider segments with tailored solutions to their needs
- Identify system issues by documenting the issue, recommend potential solution and refer appropriate technical staff
- Work with designated Provider Services specialists to deliver services tailored to the provider services
- Review claims for possible “fraud and abuse” and send to Special Investigations Unit for additional investigation
- Use continuous improvement and knowledge of claims to drive efficiency and production gains; share best practices
- Coordinate with other insurance carriers and Medicare to determine payment liability
- Represent Claims interests on divisional or enterprise project teams
Hiring Requirements
* High school diploma or GED
* 3+ years of experience in related field.
A101142RDU_1778099908
To Apply for this Job Click Here
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Beacon Hill is an Equal Opportunity Employer that values the strength diversity brings to the workplace. Individuals with Disabilities and Protected Veterans are encouraged to apply.
Founded by industry leaders to set a new standard in search, career placement and flexible staffing, we deliver coordinated staffing solutions with unparalleled service, and a passion for innovation, creativity and continuous improvement.
Our niche brands offer a complete suite of staffing services to emerging growth companies and the Fortune 500 across market sectors, career specialties/disciplines and industries. Over time, office locations, specialty practice areas and service offerings will be added to address ever changing constituent needs.
We look forward to working with you.