This is an in person position NOT remote.
Schedule is Monday to Thursday 8am to 5pm, Fridays 8am to 2:30pm.
EXPERIENCE AND EDUCATION REQUIREMENTS:
Foreign Medical Graduate or International Medical Graduate.
Be fluent in English and Spanish Language
At least 1 year of experience working in the insurance field is preferred.
Must be proficient in computer skills and have strong knowledge of Microsoft Outlook, Windows, Excel, and Word.
Must possess time management, organizational, problem solving, and customer service skills.
Must be able to work well under pressure with multiple priorities and meet deadlines.
Must be able to multitask while maintaining attention to details.
JOB ESSENTIAL REQUIREMENTS:
Must possess excellent organization, interpersonal and communication skills
Must demonstrate sound judgment and decision-making ability
Must exercise logic and common sense when confronted by varying circumstance or conditions not covered by established practices or procedures.
WORKING ENVIRONMENT:
Must be able to perform in a very high paced environment and professionally handle interruptions.
Must have the ability to work under minimal supervision.
Must be able to prioritize projects, work multiple projects simultaneously, and meet project deadlines.
Must possess excellent problem-solving skills and have keen attention to details.
Must demonstrate strong written and verbal communication, interpersonal, and relationship building skills.
Must be able to handle stressful situations appropriately.
Must maintain confidentiality and privacy in every aspect of the job.
GENERAL JOB DUTIES AND RESPONSIBILITIES:
Processing and adjudication of claims which includes
Opening and labeling the claim files once the claims have been assigned
Photocopying/ scanning the claims for proper file maintenance
Analyzing the claims to proper adjudicate it according to the policy coverage and limitations
Responsible for all email and phone calls with clients and agents regarding the assigned cases
Responsible for investigating any medical information needed to proper process the case.
Create letters to providers (USA, Latin American and/or the Caribbean) requesting specific information or providing them information or explanation on a claim processed.
Responsible for writing and submitting letters of denial well of letters of exclusionary riders or cancellation of coverage to the Insureds when necessary.