Claims Reviewer

2 months ago

Philadelphia, United States Angeion Group LLC Full time
Job DescriptionJob DescriptionJob description

The essential functions, duties, and responsibilities include, but are not limited to the following:

  • Data entry, annotation and review of documentation submitted for various administered projects.
  • Recognize discrepancies or lack of information within claim documentation and take appropriate action.
  • Contact claimants via phone to obtain/verify information when necessary.
  • Maintain acceptable levels of productivity and accuracy.
  • Perform general clerical duties to include but not limited to: photocopying, mailing, scanning, filing, and contacting claimants as needed via phone and email.
  • Audits, reviews claim to ensure accuracy and compliance with processing standards
  • Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
  • Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
  • Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
  • Identifies any inconsistencies within the report and contacts the Provider to obtain clarification, modification or correction as needed.
  • Other projects and duties as assigned.

Remote, $22/hour w/ benefits 

The essential qualifications include, but are not limited to the following:

High School Diploma / GED (or higher) and 1-3 years of the following:

  • Hands on claims experience (preferably legal claims)
  • Excellent attention to detail
  • Strong communication skills, both written and verbal
  • Ability to be flexible to adapt and act quickly when urgent matters require it
  • Able to work effectively with diversified individuals of various ethnic backgrounds and professional competencies
  • Project a positive, professional image toward clients, vendors and staff in all interactions and situations
  • Aggressive problem diagnosis and creative problem-solving skills
  • Maintain the highest level of confidentiality and share only on a need to know basis
  • Display the technical skills necessary to perform all job functions
  • Project a positive, professional image toward clients, vendors and staff in all interactions and situations
  • Follow all company rules, policies and practices
  • Excellent computer skills
  • Must be presently authorized to work in the U.S. without a requirement for work authorization sponsorship by our company for this position now or in the future

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.

While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.

This position requires the ability to analyze many variables and choose the most effective course of action at any given point in time. You must be able to handle multiple tasks and diverse work problems daily. You must be able to handle stressful situations and interact with various types of customers, while also prioritizing your work load.

NOTE

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.

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