Description

Process and adjust health claims, manage grievances, and resolve complex coverage issues using specific policies and benefit contracts.

This role is remote.

Responsibilities

• Process complex claims by applying knowledge of pricing, government regulations, and coordination of benefits (COB).
• Analyze claims and policies to determine company liability and entitlement.
• Manage grievance and reconsideration processes for various healthcare products.
• Research and resolve specific claims issues and respond to customer inquiries.

Required Skills

• 1+ years of experience in claims processing.
• Working knowledge of healthcare terminology and products including HMO, PPO, and COB.
• Proficiency using database systems.
• Experience with word processing and spreadsheet software.
• Understanding of benefit contracts, pricing, and coordination of benefits.
• Ability to work independently with minimal guidance.

Preferred Skills

• High school diploma or equivalent, or equivalent combination of education and experience.

Key Skills

Education

ANY GRADUATE