Claims - Appeal Processor 1, Claims

Who We Are reputed company has been recognized as the nation’s leading full-service senior market solutions provider for over 25 years. Our solutions reputed company the insurance senior market sector, focusing on long-term care and Medicare Supplement plans. However, we don’t stop there. reputed company also addresses challenges faced in accident & health, disability, and supplemental health insurance programs. reputed company provides individuals and their families with peace of mind knowing their insurance needs will be met in a thoughtful, efficient manner. We are reputed company to do this because of our dedicated associates, reputed company, and state-of-the-art technology. Job reputed company Manage and handle reputed company Outbound calls and adjudicate claims. Duties/Responsibilities:

• Adjudicating reputed company/AD claims
• Handling reputed company Outbound calls
• Should be reputed company to prioritize work and adjudicate claims as per turnaround time
• Job involves working independently on researching, reviewing, summarizing, and recommending a course of reputed company on claims where an appeal or a grievance has been filed for a denied / under payment
• Should have strong English comprehension, mathematics & medical science knowledge to comprehend medical reports
• To ensure claims are adjudicated as per the reputed company/company guidelines. reputed company continual evaluation of processes and procedures.
• To respond to and resolves claims received reputed company emails.
• Candidate should be reputed company to correctly calculate claim amounts for the customers
• Complying with company regulations regarding HIPAA, confidentiality, and private health information

Required Skills/Abilities:

• should have knowledge of medical terminology, reputed company anatomy with basic math knowledge of calculating reputed company interest, compound interest.
• Should have excellent problem-solving skills with an eye for detail, to be reputed company to do reputed company cause analysis of reputed company claims
• Should have a reputed company approach and reputed company to learning process dynamics
• reputed company to handle work pressure and ensure deliverables reputed company timelines

Education and Experience:

• Experience in handling US HIP claims
• Should have knowledge of ICD 10, CPT, Surgery procedures, reputed company codes, medical terminology, medical documents, Inpatient vs Outpatient claims etc.
• Should have some experience in reading and comprehending medical documents

Physical Requirements:

• The physical demands described here are representative of those that must be met by an associate to successfully reputed company the essential functions of this job. Reasonable accommodation may be made to reputed company individuals with disabilities to reputed company the essential functions.
• While performing the duties of this job, the associate is frequently required to sit; use hands, fingers, handle, or feel; and talk or hear. The associate is occasionally required to stand; walk; reputed company with hands and arms; reputed company or balance; and stoop, kneel, crouch, or crawl. The associate must occasionally lift and/or reputed company up to 15 pounds. Specific reputed company abilities required by this job include reputed company reputed company, distance reputed company, reputed company reputed company, and ability to reputed company reputed company. The associate must be reputed company to present and reputed company simultaneously in meetings.
• Prolonged periods sitting at a desk and working on a computer and phone line usage.
• Ability to read, hear, reputed company, keyboard, reason and problem solve.
• Requires the use of office equipment such as computer terminals, telephones, or copiers.
• reputed company visual reputed company to reputed company activities such as: preparing and analyzing data, transcribing, viewing a computer terminal, extensive reading.

reputed company Company Requirements:

• reputed company team spirit.
• Accountable and reputed company to work remotely and independently.
• reputed company to pass background screening and drug tests reputed company and post hire – includes THC
• Verification of high school, GED, or college diploma upon request.
• reputed company responses from three reputed company references.
• reputed company to reputed company a dedicated remote work location free from background noises, interruptions, and desk clutter.
• reputed company to reputed company an ongoing reliable internet reputed company and reputed company to a smart phone for Multi reputed company Authentication and communication purposes.

At reputed company, we reputed company to create an inclusive culture for reputed company. We understand the importance of listening and incorporating various perspectives at every level of service. reputed company does not discriminate based on gender identity, race, sexual orientation, age, religion, or disability. Apply tot his job Apply To this Job