Claims Specialist
2 months ago
The Clams Specialist works with and reports to the Department Manager. The position is located at 75 Valencia Ave #801, Coral Gables, FL 33134.
Job Essential Duties and Responsibilities: To perform the job successfully, an individual must be able to perform each essential duty satisfactory. The requirements listed below are representative of the knowledge, skill and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Medical, dental and vision claims adjudication.
- A minimum of 1 year of Healthcare Claims processing experience is required
- Utilize MWG Administrators Policy Administration System and Claims Management Software to verify eligibility and review members accounts based on the policy assigned.
- Input data into MWG Administrators Claims Management Software.
- Handle incoming mail, provider appeals, inquire, and racers. Review member correspondence and process or direct to the appropriate department.
- Maintain quality customer services by following customer service practices, responding to customer inquiries.
- Perform periodic audits on individual and group policies to verify claims have been paid correctly.
- Protect operations by keeping claims information confidential.
- Ensures legal compliance by following company policies, procedures, and guidelines.
- Identify and escalate issues to supervisors.
- Meet or exceed all performance metrics.
- Be knowledgeable and have a clear understanding of the business processes within Morgan White Group including all internal departments, insurance carriers, brokers/agents, and group contacts.
- Perform other duties as assigned by the Department Manager.
We have other current jobs related to this field that you can find below
-
Medical Insurance Billing
4 weeks ago
Miami, United States Alivi Full timeJob DescriptionJob DescriptionPlease Note: This is a HYBRID position requiring working on-site at our office in Miami 3 days per week.Summary:The primary responsibility of this position is to identify and analyze circumstances that result in an open claim status. This involves coordinating tasks to guarantee that both external and internal deadlines are...
-
P.I.P. Specialist
1 month ago
Miami, United States United Auto Insurance Full timeJob DescriptionJob DescriptionCOMPANY OVERVIEW:Founded in 1989, United Automobile Insurance Company is an innovative and established organization looking for Personal Injury Protection Specialists to join our team. Family-owned, UAIC, is one of the largest privately held property and casualty insurance companies in the United States. The key to our growth...
-
Collection Specialist
3 weeks ago
Miami, United States Gastromed, LLC Full timeJob DescriptionJob DescriptionJOB TITLE: Collection Specialist REPORTS TO: Revenue Cycle Manager FLSA STATUS: Non-Exempt JOB SUMMARY: In-depth knowledge of Procedural Coding, Specialist in identifying appropriate ICD10 coding based on CMS/HCC categories, CPT, HCPCS CMS 1500 FORM, Super Bill, Electronic Claims Submission and Clearing House Operations, EOB,...
-
Medicaid Specialist
3 months ago
Miami, United States Gardens Nursing and Rehab Center Full timeGardens Nursing and Rehab Center - Medicaid SpecialistLocation: Gardens Nursing and Rehab, MiamiGardens Nursing and Rehab in Miami is seeking a skilled Medicaid Specialist with a minimum of 1 year of experience to join our team. The ideal candidate will be responsible for managing all aspects of the Medicaid billing process, including eligibility...
-
Adjuster - P.I.P. Specialist
2 months ago
Miami, United States United Auto Insurance Full timeJob DescriptionJob DescriptionCOMPANY OVERVIEW:Founded in 1989, United Automobile Insurance Company is an innovative and established organization looking for Personal Injury Protection Specialists to join our team. Family-owned, UAIC, is one of the largest privately held property and casualty insurance companies in the United States. The key to our growth...
-
Revenue Cycle Specialist
3 months ago
Miami, United States Alivi Full timeSummary: The primary responsibility of this position is to identify and analyze circumstances that result in an open claim status. This involves coordinating tasks to guarantee that both external and internal deadlines are adhered to, facilitating the prompt processing and resolution of open claims. The objective is to conclusively settle all claims within...
-
Revenue Cycle Specialist
2 months ago
Miami, United States Alivi Full timeJob DescriptionJob DescriptionSummary:The primary responsibility of this position is to identify and analyze circumstances that result in an open claim status. This involves coordinating tasks to guarantee that both external and internal deadlines are adhered to, facilitating the prompt processing and resolution of open claims. The objective is to...
-
Revenue Cycle Specialist
3 weeks ago
Miami, United States Alivi Full timeJob DescriptionJob DescriptionSummary:The primary responsibility of this position is to identify and analyze circumstances that result in an open claim status. This involves coordinating tasks to guarantee that both external and internal deadlines are adhered to, facilitating the prompt processing and resolution of open claims. The objective is to...
-
Revenue Cycle Specialist
2 months ago
Miami, United States Alivi Health Full timeSUMMARYThe primary responsibility of this position is to identify and analyze circumstances that result in an open claim status. This involves coordinating tasks to guarantee that both external and internal deadlines are adhered to, facilitating the prompt processing and resolution of open claims. The objective is to conclusively settle all claims within the...
-
Medical Management Specialist
2 months ago
Miami, United States United Auto Insurance Full timeJob DescriptionJob DescriptionCOMPANY OVERVIEW:Founded in 1989, United Automobile Insurance Company is an innovative and established organization looking for a PIP Medical Management Adjuster to join our team. Family-owned, UAIC, is one of the largest privately held property and casualty insurance companies in the United States. The key to our growth and...
-
Medical Management Specialist
3 months ago
Miami, United States United Auto Insurance Full timeJob DescriptionJob DescriptionCOMPANY OVERVIEW:Founded in 1989, United Automobile Insurance Company is an innovative and established organization looking for a PIP Medical Management Adjuster to join our team. Family-owned, UAIC, is one of the largest privately held property and casualty insurance companies in the United States. The key to our growth and...
-
Insurance Verification Specialist
3 months ago
Miami, United States Marcos Consulting Group Inc Full timeJob DescriptionJob DescriptionBusy Podiatric Office looking for an insurance verification specialist. Experience with Podiatric services a plus!Conduct insurance verification and authorization validation on scheduled patients to ensure eligibility and that benefits are in order for accurate claim submission and payment.Contact the Payer directly via...
-
Customer Escalations Specialist
1 month ago
Miami, United States Assurant Full timeThe Customer Escalation Specialist is a key position within our offices. As a Customer Escalation Specialist, you'll be the primary contact for all customer escalations including inquiries from social media, regulatory agencies, legal, departments of insurance, the Better Business Bureau, and more. We are looking for an analytical candidate who knows how to...
-
Customer Experience Specialist
3 weeks ago
Miami, United States Grip Full timeJob Description:We are seeking a dedicated and enthusiastic Client Experience Specialist to join our teamin Miami, FL. As a Customer Experience Specialist, you will be the face of the companyfor our clients, responsible for ensuring customer satisfaction through exceptionalcustomer service and experience. You will play a pivotal role in fostering...
-
Customer Experience Specialist
4 weeks ago
Miami, United States Grip Full timeJob Description:We are seeking a dedicated and enthusiastic Client Experience Specialist to join our teamin Miami, FL. As a Customer Experience Specialist, you will be the face of the companyfor our clients, responsible for ensuring customer satisfaction through exceptionalcustomer service and experience. You will play a pivotal role in fostering...
-
Risk and Insurance Specialist
3 weeks ago
Miami, United States CareMax Inc Full timeJob DescriptionJob DescriptionAbout Us:HEART. It is the driving force of our commitment to serving others with empathy, respect, and dignity. CareMax, is committed to providing the best that medicine has to offer with quality healthcare for those who need it most, our seniors. Join our team and experience it for yourself. We are Health with Heart.You can...
-
DTC Retention Specialist
3 weeks ago
Miami, United States United Auto Insurance Full timeJob DescriptionJob DescriptionCOMPANY OVERVIEW:Founded in 1989, United Automobile Insurance Company is an innovative and established organization looking for a Direct-to-Consumer Retention Specialist to join our team. Family-owned, UAIC, is one of the largest privately held property and casualty insurance companies in the United States. The key to our growth...
-
Billing Specialist
3 months ago
Miami, United States Promises Behavioral Health, LLC Full timeJob DescriptionJob DescriptionNOTE: Experience within the Behavioral Health Industry is required. This is a fully remote position, however we are recruiting specifically from the South Florida region.Position Summary Responsibilities involve billing of institutional and professional claims to various insurance companies/payers. The biller will audit and...
-
Billing Specialist
3 weeks ago
Miami, United States Promises Behavioral Health, LLC Full timeJob DescriptionJob DescriptionNOTE: Experience within the Behavioral Health Industry is required. This is a fully remote position, however we are recruiting specifically from the South Florida region.Position Summary Responsibilities involve billing of institutional and professional claims to various insurance companies/payers. The biller will audit and...
-
Credentialing Specialist
1 month ago
Miami, United States BilliMD Full timeCompany DescriptionAt BilliMD, we specialize in simplifying medical billing and revenue cycle management. Our end-to-end solutions integrate seamlessly with EHR/EMR systems, freeing your staff from manual tasks and allowing them to focus on patient care. We have a team of certified coders, seasoned professionals, and healthcare experts who are dedicated to...
