Job Description:
Responsible for responding to routine inquiries. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures.
Responsibilities:
40% Responds to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met. Accurately documents inquiries. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
40% Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Ensures claims are processing according to established quality and production standards.
20% Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution. Identifies and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.
Experience:
1 Year Customer service or claims processing experience
Skills: Strong oral and written communication skills. Proficient in spelling, punctuation, and grammar. Strong organizational, analytical, and customer service skills. Ability to handle high stress situations. Basic business math proficiency. Ability to handle confidential or sensitive information with discretion. Ability to learn and operate multiple computer systems effectively and efficiently. Required Software and Other Tools: Microsoft Office. Preferred Sills and Abilities: Ability to persuade, negotiate or influence. Preferred Software and Other Tools: Knowledge of database software. Work Environment: Typical office environment.
Education:
Required Education: High School
About US Tech Solutions:US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity,national origin, disability, or status as a protected veteran.