Senior Claim Benefit Specialist - Operations

Full-time - Entry Level

Work from home, AZ

Health and Personal Care Retailers

About the position

The Senior Claim Benefit Specialist (OPS) reviews, researches and adjudicates complex, sensitive, and/or specialized encounters in accordance with State driven encounter processing guidelines. May be required to learn multiple Medicaid plans. Medical claims processing experience is a basic requirement. This role involves working to research and resolve encounter errors, ensuring all compliance requirements are met, and identifying and reporting possible claim overpayments, underpayments, scanning issues and any other irregularities.

Responsibilities

• Research and resolve encounter errors
• Ensure all compliance requirements are met
• Identify and report possible claim overpayments, underpayments, scanning issues and any other irregularities

Requirements

• 2 years Medical Claims processing experience (Commercial, Medicaid, Medicare, etc.)
• Experience in a production environment
• Analytical skills, with the ability to research particularly in areas involving rejected claims
• Demonstrated ability to handle multiple assignments competently, accurately, and efficiently
• Demonstrated proficiency with personal computer, keyboard navigation skills, and MS Office Suite applications

Nice-to-haves

• QNXT claims processing experience
• Encounters experience
• Edifecs knowledge

Benefits

• Full range of medical, dental, and vision benefits
• 401(k) retirement savings plan
• Employee Stock Purchase Plan
• Fully-paid term life insurance plan
• Short-term and long-term disability benefits
• Well-being programs
• Education assistance
• Free development courses
• CVS store discount
• Discount programs with participating partners
• Paid Time Off (PTO) or vacation pay
• Paid holidays throughout the calendar year