SPE-Claims HC

Job Summary
We are seeking a skilled Claims Adjudication Specialist with 3 to 5 years of experience to join our team. The ideal candidate will have a strong background in claims adjudication processes and a keen eye for detail. This work-from-home position requires a proactive individual who can efficiently manage claims and contribute to our companys success in the healthcare sector. The role is crucial in ensuring accurate and timely claims processing ultimately benefiting our clients and the broader co

Responsibilities

• Review and analyze claims to ensure accuracy and compliance with established guidelines.
• Process claims efficiently ensuring timely adjudication and resolution.
• Collaborate with team members to identify and resolve discrepancies in claims data.
• Utilize claims adjudication software to manage and track claims processing.
• Communicate effectively with stakeholders to provide updates on claims status.
• Identify trends and patterns in claims data to improve processing efficiency.
• Ensure adherence to regulatory requirements and company policies in all claims activities.
• Provide support and guidance to team members on complex claims issues.
• Maintain accurate records of claims processing activities for audit purposes.
• Contribute to the development of process improvements to enhance claims adjudication.
• Participate in training sessions to stay updated on industry changes and best practices.
• Engage in continuous learning to enhance skills and knowledge in claims adjudication.
• Support the companys mission by ensuring high-quality claims processing that meets client needs.

Qualifications

• Possess strong analytical skills to evaluate and process claims accurately.
• Demonstrate proficiency in using claims adjudication software and tools.
• Exhibit excellent communication skills to interact with stakeholders effectively.
• Have a keen attention to detail to identify and resolve claims discrepancies.
• Show a proactive approach to problem-solving in claims processing.
• Display a solid understanding of healthcare claims and related regulations.
• Possess the ability to work independently in a remote work environment.

Certifications Required
Certified Professional Coder (CPC) or equivalent certification in claims adjudication.