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Senior Assistant Claims Examiner

3 months ago

Topeka, United States US Tech Solutions Full time

Note: Hybrid Work (depends on business needs) after one week of onsite training

Hire Type: 12+ months Contract (High possibility of extension/conversion)

The location will be in Topeka KS - hybrid once trained. Some days at home and some days in office depending on business needs.



Job Description:

Our Client makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives.

We are seeking a talented individual for a Senior Assistant Claims Examiner who is responsible for processing all who is responsible for processing all probate and estate functions involving several state Medicaid beneficiaries or deceased Medicaid beneficiaries. This includes intake, maintenance, claims review and selection, asset investigation, court filings and deadline management, settlement and other related functions to the case. Medicaid beneficiaries. This includes claims review and selection, management of case workflow, settlement and related functions

Responsibilities:

Interact professionally (i.e. on incoming and outgoing calls) with attorneys, insurance adjusters, medical providers, court staff, recipients and family members and client.
Effectively maintain and manage a variety of cases with current and accurate notes from creation to recovery
Maintain a daily system of providing timely and accurate information required to move cases through the case management workflow.
Daily telephone contact with counterparties, including attorneys, adjusters and healthcare providers
Independently work cases of high dollar value up to and through settlement
Confirm and validate third party liability and, probate and beneficiary asset research.
Prepare required correspondence, liens, claims and other related documents to progress the case to recovery.
Negotiate and compromise claim/lien settlement amounts per contract guidelines.
Process all claim/lien disputes and review claims with attorneys and other stakeholders.
Conduct outgoing follow up on case status and payment.
Perform basic and advanced levels of document review to identify current case status, legal research, and case management and ensure case progress through workflow
Prioritize case events and critical case payment/recovery issues, while meeting, various internal and legal deadlines that are revenue impacting.
Compile, analyze and make conclusions about case information and status from multiple sources.
May serve as an escalation point for assistant claims examiner



Knowledge and Skills:

Ability to interact with all levels of people both internally and externally in a professional manner.
Ability to be careful and thorough about detail including with cite-checking and proof-reading skills.
Ability to multi-task and prioritize effectively.
Ability to work proficiently with Microsoft Office, PowerPoint, Word, and Excel required
Ability to work independently to meet objectives.
Ability to analyze information and use logic to address work-related issues and problems.
Ability to perform well in team environment, to achieve business goals.
Ability to maintain a high level of confidentiality and ethics.
Ability to handle pressure and manage deadline oriented project demands and multiple initiatives.



Education:

High School Diploma.

Experience:

Experience in a Legal office a plus; paralegal or legal assistant and/or experience in the insurance industry (casualty or health insurance) a plus
Knowledge of Microsoft Word and Excel required.
Basic knowledge of Microsoft Access preferred.
Medicaid and/or Medicare knowledge preferred.
Bilingual (Spanish & English) a plus.


About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Recruiter Details:

Name: Chandrakant

Email: chandrakant@ustechsolutions.com

Internal Id: 24-17862