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Healthcare Claims Specialist - REMOTE

3 months ago
United States
Full-time
Mid Level
Manual QA Tester
Quality Assurance and Testing
Salesforce
Apply Now
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
View All Jobs 2

Description

  • Review and process claims in the claims transactional system according to plan benefits and contractual reimbursement terms.
  • Pay, pend, or deny claims based on established policies and procedures.
  • Process claims subject to Coordination of Benefits (COB) rules and requirements.
  • Meet established department production and quality standards.
  • Create claim test cases, execute testing, and report results.
  • Identify, communicate, and help remediate claim system defects and configuration issues.
  • Track and communicate inventory issues to department management.
  • Collaborate with internal departments, vendors, business partners, and providers to resolve problems efficiently.
  • Develop and maintain desktop procedures related to claim adjudication.
  • Audit auto-adjudicated and manually processed claims.
  • Participate effectively in a virtual work environment through team huddles, 1:1s, messaging, and check-ins.

Requirements

  • Minimum of 3 years of medical claim adjudication or examination experience.
  • Experience working for a health insurance carrier, health insurance TPA, or equivalent.
  • Knowledge of medical and insurance terminology, including CPT, ICD-10, HCPCS, and Revenue Codes.
  • Strong attention to detail, problem-solving skills, and a high level of accuracy.
  • Experience writing desktop procedures.
  • Excellent verbal and written communication skills.
  • Ability to work in a fast-paced, deadline-oriented environment.
  • Proficiency with Microsoft Office applications, including Word, Excel, Outlook, and OneNote.
  • Prior experience using a CRM, preferably Salesforce.
  • Prior experience with claim testing and/or auditing.
  • Experience supporting business and operational units such as Customer Service, Medical Management, and Appeals and Grievance.
  • Certified Coding Specialist (CCS) or Certified Coding Professional (CPC) preferred.
  • Plexis or Quantum Choice experience is a bonus.
  • Must live in the United States within the CST or EST time zones.
  • Must have a dedicated private work area and a high-speed internet connection.

Benefits

  • Competitive salary of $55,000 to $60,000 per year.
  • Comprehensive health, dental, and vision insurance.
  • Life and disability insurance.
  • Retirement savings plan with company match.
  • Generous time off and vacation.
  • Professional development opportunities.
  • Flexible work environment.
  • Fully remote work arrangement.

Interested in this position?

Apply directly on the company website

Apply Now

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