CSR II Adjudication
4 weeks ago
DEPARTMENT: Operations
REPORTS TO: Supervisor
FLSA STATUS: Non-Exempt
OUR GUIDING PRINCIPLES:
Make every interaction Count
Act with Respect and Integrity
Demonstrate Passion for Continuous Improvement
Be Worth of Trust from all Stakeholders
OVERVIEW:
The Customer Service Representative II (Adjudication) ensures compliance with client's program specifications and SaviLinx policies and procedures. This position is responsible for the accurate review, input, and adjudication of claims.
ESSENTIAL FUNCTIONS:
- Demonstrates ability to work in accordance with the Savilinx Guiding Principles.
- Supports the day-to-day processing of claims for a contract with the following duties.
- Acknowledges establishment of new claims assigned daily.
- Accepts telephone calls from claimants.
- Adjudicates claims within guidelines ensuring the benefit eligibility is correctly determined.
- Researches and resolves escalated and complex claim issues in a timely manner.
- Reviews supporting documentation for accuracy.
- Connects with applicants to guide them through the claim process.
- Maintains and follows-up on pending files, as required by guidelines.
- Practices all policies and procedures to PHI and HIPAA.
- Documents all claimant information, communications in CRM system.
- Ensures privacy, confidentiality, and precision with all work.
- Maintains a working knowledge of our clients' requirements.
- Regular and consistent attendance is an essential function of the job.
No Supervisory responsibility.
EXPECTED WORKDAYS/ HOURS:
This position requires work Monday-Friday 8am-5pm.
LOCATION:
Work from Home based on performance and internet connectivity.
QUALIFICATIONS:
- 2+ years of contact center experience preferred.
- High school diploma or equivalent required.
- Time management skills and the ability to work independently are essential for this role.
- Must have experience with maneuvering electronic data between various environments.
- Analytical thinking, communication and writing skills, and computer competencies.
- Prior experience with PHI or HIPAA preferred
- 2+ years of college preferred.
Please note, this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time, with or without notice.
EQUAL EMPLOYMENT OPPORTUNITY:
SaviLinx, LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
VEVRAA FEDERAL CONTRACTOR/EQUAL OPPORTUNITY EMPLOYER
-
CSR II Phones
2 weeks ago
Lawrence, Massachusetts, United States SaviLinx Full timeJOB TITLE: Customer Service Representative II Phones ($18.50/hr + $1/pay for performance, remote)DEPARTMENT: Operations REPORTS TO: Supervisor FLSA STATUS: Non-Exempt OUR GUIDING PRINCIPLES: Make every interaction Count Act with Respect and Integrity Demonstrate Passion for Continuous Improvement Be Worth of Trust from all Stakeholders OVERVIEW: The...
-
Medical Science Specialist
2 days ago
Lawrence Twp, United States Bristol-Myers Squibb Full timeAbout the RoleThe Medical Science Specialist will work closely with cross-functional teams to develop and implement clinical trial strategies. This individual will be responsible for planning, executing, and monitoring clinical trials, as well as providing scientific and clinical leadership to a team of supporting Clinical Scientists.ResponsibilitiesMaintain...
-
Senior Clinical Operations Professional
1 day ago
Lawrence Twp, United States Bristol-Myers Squibb Full timeKey QualificationsThe ideal candidate will have 5+ years of experience in clinical science, clinical research, or equivalent. Proficient knowledge of GCP/ICH, drug development process, study design, statistics, clinical operations is required.ResponsibilitiesMaintain a thorough understanding of assigned protocols and protocol requirements; educate supporting...
-
Lawrence Twp, United States Bristol-Myers Squibb Full timeAbout the RoleThe Clinical Research Coordinator Senior will be responsible for implementing, planning, and executing assigned clinical trial activities. This individual will serve as Clinical Trial Lead for one or more trials, successfully leading, planning, and executing trial level activities for multiple trials with minimal to moderate level of...
-
Clinical Research Coordinator Senior
2 days ago
Lawrence Twp, United States Bristol-Myers Squibb Full timeCompany OverviewBristol-Myers Squibb is dedicated to transforming patients' lives through science. Our employees play an integral role in this mission, empowered to apply their individual talents and unique perspectives in an inclusive culture promoting diversity in clinical trials.About the JobWe are seeking a Clinical Research Coordinator Senior to join...
-
Clinical Scientist
4 days ago
Lawrence Township, United States Omni Inclusive Full timePosition is onsite at either Princeton Pike, NJ, Madison, NJClinical Scientist, Early DevelopmentResearch and Early DevelopmentThe Early Development Clinical Scientist function provides scientific expertise necessary to design and deliver clinical studies and programs.• Responsible for design and execution of assigned clinical trial activities and works...
-
Senior Clinical Scientist, Psychiatry
2 days ago
Lawrence Twp, United States Bristol-Myers Squibb Full timeWorking with UsChallenging. Meaningful. Life-changing. Those aren't words that are usually associated with a job. But working at Bristol Myers Squibb is anything but usual. Here, uniquely interesting work happens every day, in every department. From optimizing a production line to the latest breakthroughs in cell therapy, this is work that transforms the...
