Senior Claims Specialist – Claims Processing

Role Overview

• Responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, per diem, case rate etc.)
• Adjudication and claims research when necessary
• Must have knowledge of compliance issues as they relate to claims processing
• Ability to identify and address non-contracted providers.

Requirements

• 2 years Claims pricing and processing experience in ambulatory, acute care hospital, HMO or IPA environment
• Experience processing all types of medical claims outpatient/inpatient UB-04 and HCFA-1500 claims as well as others.
• Experienced in interpreting provider contract reimbursement terms.

Benefits

• Comprehensive benefits package
• Retirement 401(k) Savings Plan with employer matching
• Health care benefits (medical, dental, vision)
• Life insurance
• Disability insurance
• Time off benefits (paid parental leave, vacations, holidays, health issues)
• Voluntary benefits
• Well-being resources