Claims Specialist

Claims Operations

Remote, United States

Now is the time to join us! 

Who are you?

Claims Specialist complete claim processing tasks and duties while performing best practices in time management, inventory, quality and procedures. HealthComp is an Equal Opportunity Employer that does not discriminate on the basis of any characteristic or activity protected by federal, state or local laws. This Job Description is a summary of the essential functions and tasks that will generally be expected of this position. HealthComp reserves the right to change this Job Description without notice.

In this role you will wear many hats, but your knowledge will be essential in the following:  

• Maintain quality and procedure standards including compete review and examination of claim to ensure proper handling in accordance to company policies and procedures.
  
  • Financial Accuracy – 99%
  • Payment Accuracy – 99%
  • Procedural Accuracy – 97%
• Complete claims task in timely manner and maintain production requirement:
  
  • 150 claims per day
  • Claims processing – 10 calendar day or as specified by performance agreement
  • CSCL – 3 business days
  • Email Responses – 24 hours
  • Correspondence – 10 calendar day or as specified by performance agreement
• Review and understand plans, documents and vendors. Ensure proper system setup while processing claims. Identify and report to management any potential errors, problems or issues regarding plan documents, claims processing or system setup.
• Work stop loss renewal process, as directed by management.
• Complete all training requirements in a timely manner, as directed by management.
• Understand and enforce company procedures, polices and standards.
• Practice good follow up procedures to ensure completion of task and/or inquiries.
• Direct client contact, internal staff and vendor support to ensure customer and member satisfaction.
• Support management team with projects and special request

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

What you bring to the Personify Health team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

• Required – High School Diploma

• Preferred – Associates Degree in Business

   

• Schedule:

  • Monday- Friday

  • Start time 7:00am and 9:00am

  • Shift 8 Hours

     

• Experience (Years of Experience/Skills/Abilities):

• Required – 2 years claims processing

• Preferred – 5+ years claims processing in the QicLink system

• Must be able to establish and maintain good working relationship with clients and provide excellent customer service

• Must be computer literate and knowledgeable in Windows and Microsoft Office environment, including Word, Outlook and Excel. Knowledge of insurance database system a plus.

• Ability to work with others to accomplish mutual goals

• Healthcare industry experience strongly preferred, specifically in healthcare, health insurance, medical office or clinical experience at a front desk, in billing or admissions

• Remote work is possible depending on experience and business needs

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $20.00 to $28.00. Note that salary may vary based on location, skills, and experience. This position is eligible for  health, dental, vision, mental health and other benefits.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.

#WeAreHiring #PersonifyHealth