Job Title: Claims Specialist
Location: Tampa, FL (Hybrid - 2 days onsite and 3 days remote)
Duration: FULLTIME
JOB DESCRIPTION:
As a Claims Processor you'll be responsible for reviewing and processing insurance claims to determine the appropriate action to be taken. This role involves gathering information, evaluating claims for validity, and ensuring that all necessary documentation is complete.
PRINCIPAL RESPONSIBLITIES
• Medical Claims Processing - Accurately review, verify and process insurance claims following the company policies/SOPs.
• Documentation Review - Analyze claim documents, medical records, benefit summary to determine claim eligibility and process the claim as per the benefit.
• Customer and Internal Business Partner Interaction - Communicate with member, healthcare providers and internal business partners to resolve the claim or gather required additional information.
• Data Entry - Enter claim details and maintain accurate records within the claims management system.
• Problem resolution - Investigate discrepancies and resolve disputes related claim processing
• Rework Adjustment Experience - Should be able to perform the rework adjustment basis the provider request and internal rework/adjustment requirement.
• Continuous improvement - Identify process improvement opportunities to enhance claims accuracy and efficiency.
...be comfortable with frequent travel and be able to generate new sales leads on a regular basis. The candidate should be able to keep track... ...team Qualifications ~ Bachelor's degree ~2- 5 years of B2B sales experience ~ Strong work ethic and communication skills...
...The Quantitative Analyst will develop tools for identifying investment opportunities, manage risk, and build automated reconciliation and reporting systems across the firms proprietary platforms. The ideal candidate should have strong analytical and problem-solving skills...
Reports to Manager, Volunteer & Community Engagement Organization Overview Baby2Baby is a national non-profit organization that provides children living in poverty with diapers, formula, clothing, and the basic necessities that every child deserves, serving more...
...Our client is hiring for an ENTRY LEVEL B2B Sales Representative ! Looking for outgoing, people-oriented individuals with a high level of ambition. Candidates who enjoy interacting with people, thrive in a team environment, and want career advancement opportunities...
...SUMMARY The Salesforce Administrator will manage and support our Salesforce CRM system, ensuring data integrity, supporting users, and leading... ...and manage data integrity within Salesforce, including data entry, validation, and cleansing and user management. Ensure...