Claims Examiner

3 weeks ago

Trenton, United States BCFORWARD TECHNOLOGIES PRIVATE LIMITED Full time
_*BCforward is currently seeking a highly motivated Claims Representative Role at Trenton, NJ.*_

*Position Title: *_*Claims Representative *_
*Location: *_*Trenton, NJ.*_
*Expected Duration: 12+ Months with a Strong possibility of Extension.*

*Job Type: Contract 40hr week/Onsite *

*Job Description:*
* Follows adjudication policies and procedures to ensure proper payment of claims.
* Resolves pending claims based on Medicaid rules and regulation established for final processing.
* Resolves claims resolution and/or adjustments/voids.
* Processes claim adjustments through Reversal/Replacement requests submitted by providers.
* Prices claims manually as required by Medicaid rules and system limitations as defined by policy and departmental procedures.
* Meets established production requirements consistently.
* Maintains an accuracy rate of 98% or better.
* Processes financial transactions.
* Review/Resolve LTC Production Reports.
* Data entry of LTC transactions.
* Monitor processing time & unfinished work on a daily basis.
* Process refund/return checks.
* Assist with monthly distribution of LTC TADS.
* Contributes a positive attitude to the team in order to meet department goals.
* Supports all departmental initiatives in improving overall efficiency.
* Assist in monitoring and timely processing of special batches

*Requirements*
* Basic knowledge of Microsoft Office Outlook, Word and Excel
* General knowledge of PC
* Good working knowledge of medical claims systems
* Knowledge of CPT/HCPCS and ICD9 coding procedures and guidelines
* Mathematical background a plus
* Good verbal and written communication skills
* Ability to abide by Gainwell Technologies policies
* Maintain regular attendance based on agreed-upon schedule
* Maintain confidentiality and comply with Health Insurance Portability and
* Accountability Act (HIPAA)
* Ability to establish and maintain positive and effective working relationships with
* coworkers, clients, members, providers and customers

*Benefits:*
BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

Job Type: Contract

Pay: $21.00 - $22.00 per hour

Expected hours: 40 per week

Benefits:
* 401(k)
* Dental insurance
* Health insurance
* Paid time off
* Vision insurance
Schedule:
* 8 hour shift
* Monday to Friday
Work setting:
* In-person
* Office

Ability to Commute:
* Trenton, NJ (Required)

Ability to Relocate:
* Trenton, NJ: Relocate before starting work (Required)

Work Location: In person

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