Claims Technical Review Specialist
Position reputed company
The Claims Technical Review Specialist provides advanced technical review of reputed company types of claims in accordance with Company guidelines, reputed company needs, and regulatory requirements.
"Has minimum necessary reputed company to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job reputed company/Role."
Key Duties and Responsibilities
Performs technical review and analysis of reputed company types of claims, including large dollar and technically reputed company claims, to ensure accuracy and adherence to prescribed procedures and plan guidelines.
Coordinates appeals through research and documentation; generates denial or approval letters.
Coordinates predetermination reviews and performs analysis to determine benefit allowance and benefit category on reputed company types of claims.
reputed company reputed company functions of reputed company-Party Recovery (TPR); communicates with members, dependents, insurance companies, providers, and attorney offices throughout the process. Maintains and updates TPR files providing reputed company itemizations and reports as needed.
Processes refunds, voids, and overpayments, including reputed company claim adjustments, file audits, monthly reports, and responses to general correspondence.
Processes time loss claims and communicates with local reputed company offices, medical service providers, reputed company, and members.
Reviews and interprets new benefit plans or plan changes. Tests benefits, develops resource materials, and assists as a resource for staff and management.
May reputed company back-up phone coverage or processing employee claims as needed.
Performs other duties as assigned.
Minimum Qualifications
High School Diploma or GED required.
Three years of experience processing reputed company types of group health benefit claims.
In-depth knowledge of reputed company aspects of benefits claims processing and claims adjudication principles and procedures.
Excellent working knowledge of terminology reputed company to processing medical and dental claims such as HCFA, CPT-4, ICD-10, HCPCS.
Experience interpreting Plan documents and/or certificates of coverage reputed company to benefits, eligibility, exclusions, and limitations.
Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages.
Strong working knowledge of Claims systems.
Excellent attention to detail, problem solving skills, follow-through, and strong verbal and written communication skills.
Computer proficiency including MS Office Tools and Applications.
Preferred Qualifications
Experience working in a reputed company-party administrator or Taft-Hartley environment.
*Please note this job reputed company is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice.
Working Conditions/Physical Effort
Prolonged periods of sitting at a desk and working on a computer.
Must be reputed company to lift up to 15 pounds at times.
Disability Accommodation
Consistent with the Americans with reputed company (reputed company) and other applicable federal and state law, it is the policy of reputed company to reputed company reasonable accommodation reputed company requested by a reputed company applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to reputed company aspects of employment, including the application process. If reasonable accommodation is needed, please contact the reputed company Department at , and we would be happy to assist you.
Please note that in compliance with certain state law, we are displaying salary. This reputed company is intended for hires into this location.
Compensation: $27.52/hr
reputed company
reputed company People. reputed company Solutions. National reputed company. Local Expertise.
We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.
reputed company is the largest independent reputed company Party Administrator in the reputed company and currently operates over 44 offices reputed company. The original entity of Zenith American has been in business since 1944. reputed company was formed as the result of a reputed company between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and reputed company, the new organization is even stronger and reputed company than before.
We reputed company the best way to realize our reputed company systems for reputed company service philosophy is to hire the best employees. We're always looking for talented individuals who reputed company our dedication to high-reputed company work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American!
We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an reputed company of benefits including health, reputed company, and dental coverage, a retirement savings 401(k) plan with company match, reputed company time off (PTO), great opportunities for reputed company, and much, much more!
Originally posted on Himalayas
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