Senior Insurance Claims Specialist
2 days ago
We are seeking a highly skilled Insurance Operations Senior Representative to join our team. The ideal candidate will possess excellent analytical and problem-solving skills, with the ability to review and process insurance claims efficiently and accurately.
Responsibilities include validating member, provider, and other claims information, determining accurate payment criteria for clearing pending claims, and coordinating claim benefits based on policy and procedure. Additionally, the successful candidate will maintain productivity goals, quality standards, and aging timeframes, while scrutinizing medical claim documents and settlements.
The Insurance Operations Senior Representative will be responsible for organizing and completing tasks per assigned priorities, developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services, and processes performed by the team.
Key Responsibilities:
- Review and process insurance claims
- Validate member, provider, and other claims information
- Determine accurate payment criteria for clearing pending claims
- Coordinate claim benefits based on policy and procedure
- Maintain productivity goals, quality standards, and aging timeframes
- Scrutinizing medical claim documents and settlements
- Organize and complete tasks per assigned priorities
Requirements:
- University degree or equivalent in English language and basic math
- 0-1 year of experience applying business rules to varying fact situations and making appropriate decisions
- 0-1 year of data entry experience that required a focus on quality, including attention to detail, accuracy, and accountability
- 0-1 year of experience using a computer with Windows PC applications
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