SPE-Claims HC

Job Summary

Join our team Clinical Claims Review Specialist where you will leverage your expertise in claims adjudication to ensure accurate and efficient processing of claims. With a focus on commercial claims and payer domain you will work remotely during night shifts contributing to our mission of providing exceptional service and support to our clients. Your role will be pivotal in enhancing operational efficiency and client satisfaction.

Responsibilities

• Process claims efficiently and accurately to ensure timely adjudication and resolution.
• Analyze claim data to identify discrepancies and take corrective actions to maintain accuracy.
• Collaborate with team members to streamline claims processing and improve workflow efficiency.
• Utilize claims adjudication systems to manage and track claims status and outcomes.
• Communicate effectively with stakeholders to resolve claims-related issues and provide updates.
• Ensure compliance with industry standards and regulations in all claims processing activities.
• Provide insights and recommendations to enhance claims processing strategies and reduce errors.
• Maintain detailed records of claims activities and generate reports for management review.
• Assist in the development and implementation of claims processing policies and procedures.
• Stay updated on industry trends and best practices to continuously improve claims operations.
• Support the team in achieving departmental goals and objectives through effective claims management.
• Contribute to the companys purpose by ensuring high-quality claims service that impacts society positively.
• Work independently in a remote setting demonstrating strong self-motivation and time management skills.

Qualifications

• Possess strong technical skills in claims adjudication with a proven track record.
• Have domain expertise in claims with experience in the payer domain being a plus.
• Demonstrate excellent analytical and problem-solving abilities.
• Exhibit strong communication skills for effective stakeholder interaction.
• Show proficiency in using claims adjudication software and tools.
• Display a keen attention to detail and accuracy in claims processing.
• Have the ability to work independently and manage time effectively in a remote work environment.

Certifications Required

BSC Nursing with Mon 2 + years of Clinical Experience