Healthcare Claims Specialist - Remote

12 minutes ago
Full-time
Mid Level
Operations
Evry Health

Evry Health

Evry Health is a modern health insurance company that prioritizes delivering great benefits at affordable prices. They offer a unique approach to health insurance by focusing on making members healthier and happier through personalized care from a dedi...

Insurance
11-50
Founded 2017
$7M raised

Description

  • Review and process claims in the claims transactional system according to plan benefits and contractual reimbursement terms.
  • Determine whether claims should be paid, pended for additional information, or denied.
  • Process claims subject to Coordination of Benefits (COB) rules and contractual reimbursement terms.
  • Test claim configuration and benefit setup by creating, executing, and reporting on claim test cases.
  • Audit auto-adjudicated and manually processed claims to ensure accuracy.
  • Identify, communicate, and help remediate defects or issues in the claim system.
  • Work with internal departments, vendors, business partners, and providers to resolve claims-related issues.
  • Develop, write, and maintain desktop procedures related to claim adjudication.
  • Meet established department production and quality standards.
  • Participate actively in virtual team huddles, one-on-ones, and check-ins.

Requirements

  • Minimum of 3 years of medical claim adjudication or examination experience with a health insurance carrier, TPA, or equivalent.
  • Knowledge of medical and insurance terminology, including CPT, ICD-10, HCPCS, and Revenue Codes.
  • Strong attention to detail, problem-solving ability, and high accuracy.
  • Experience writing desktop procedures.
  • Excellent verbal and written communication skills.
  • Ability to work effectively in a fast-paced, deadline-oriented environment.
  • Proficiency in Microsoft Office applications, including Word, Excel, Outlook, and OneNote.
  • Prior experience using a CRM, preferably Salesforce.
  • Prior experience with claim testing and/or auditing.
  • Certified Coding Specialist (CCS) or Certified Coding Professional (CPC) preferred.
  • Bonus: experience with Plexis/Quantum Choice.

Benefits

  • Competitive salary of $55,000 - $60,000 a year.
  • Comprehensive health, dental, and vision insurance.
  • Life and disability insurance.
  • Retirement savings plan with company match.
  • Generous time off/vacation.
  • Professional development opportunities.
  • Flexible work environment with fully remote work.
  • Remote role with company-provided business hours and time zone requirements.

Interested in this position?

Apply directly on the company website

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