Medical Claims Specialist

2 weeks ago

Trenton, United States V R Della IT Services Private Limited Full time

This position involves:

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

Requirements

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

#NonMedical1

Job Types: Full-time, Contract

Pay: $23.00 per hour

Benefits:
* Dental insurance
* Health insurance
* Vision insurance
Schedule:
* 8 hour shift
* Day shift
* Monday to Friday

Experience:
* Medical Claims: 2 years (Required)
* CPT/HCPCS and ICD9: 2 years (Preferred)
* HIPAA: 2 years (Preferred)
* Healthcare: 2 years (Required)

Ability to Relocate:
* Trenton, NJ 08610: Relocate before starting work (Required)

Work Location: In person

  • Claims Specialist

    2 months ago

    Trenton, United States Datawize Technologies LLC Full time

    **Claims Specialist** **Shift timing: 8:30 AM to 4:00 PM** **Lunch: 1/2 hour (unpaid)** **Location: 20 W. State Street, Trenton, NJ 08625** **Job Type: Contract** **Job Duration: 1 Month** **Job Description: - ** - Under the direction of a supervisor, determines compensability of Workers Compensation claims filed by State government employees against the...

  • Claims Eligibility Specialist

    1 week ago

    Trenton, United States Ohm Systems, Inc Remote Work Freelance Full time $25 - $26

    Summary: We are looking for a temporary Claims Eligibility Specialist to join our team under the supervision of the Billing Unit supervisor. The role involves processing fee-for-service claims, handling billing and eligibility inquiries, and performing other billing-related tasks. The ideal candidate will have a solid understanding of medical billing and...

  • Claims Eligibility Specialist

    1 week ago

    Trenton, United States Ohm Systems, Inc Remote Work Freelance Full time $25 - $26

    Summary: We are looking for a temporary Claims Eligibility Specialist to join our team under the supervision of the Billing Unit supervisor. The role involves processing fee-for-service claims, handling billing and eligibility inquiries, and performing other billing-related tasks. The ideal candidate will have a solid understanding of medical billing and...

  • Complex Claim Specialist

    3 days ago

    Trenton, United States NJM Insurance Group Full time

    **Personal, compassionate service is what we’re known for at NJM. We seek the best and brightest to help our customers when they need us most. As part of the NJM team, you'll not only enjoy some of the best benefits in the industry, you'll also be joining a company that's committed to professional development, diversity and innovative thinking.**- -...

  • Claims Specialist

    2 months ago

    Trenton, United States Datawize Technologies Inc Full time

    Claims Specialist Shift timing: 8:30 AM to 4:00 PM Lunch: 1/2 hour (unpaid) Location: 20 W. State Street, Trenton, NJ 08625 - Under the direction of a supervisor, determines compensability of Workers Compensation claims filed by State government employees against the State of New Jersey. - Oversees medical case management for assigned files, and authorizes...

  • Claims Specialist

    2 weeks ago

    Trenton, United States Datawize Technologies Inc Full time

    Claims Specialist Shift timing: 8:30 AM to 4:00 PM Lunch: 1/2 hour (unpaid) Location: 20 W. State Street, Trenton, NJ 08625 - Under the direction of a supervisor, determines compensability of Workers Compensation claims filed by State government employees against the State of New Jersey. - Oversees medical case management for assigned files, and authorizes...

  • Claims Account Specialist

    2 months ago

    Trenton, United States NJM Insurance Group Full time

    NJM's Workers' Compensation Claims Team is seeking a Claim Account Specialist. This is a full-time position and offers a hybrid schedule after training. The Claims Account Specialist will be responsible for contacting all parties involved in the claim, gathering, and securing all necessary information to effectively evaluate the claim and implement an action...

  • Claims Account Specialist

    3 weeks ago

    Trenton, United States NJM Insurance Group Full time

    NJM's Workers' Compensation Claims Team is seeking a Claim Account Specialist. This is a full-time position and offers a hybrid schedule after training. The Claims Account Specialist will be responsible for contacting all parties involved in the claim, gathering, and securing all necessary information to effectively evaluate the claim and implement an action...

  • Claims Resolution Specialist

    2 months ago

    West Trenton, United States NJM Insurance Group Full time

    The Claim Resolution Specialist 1 will be responsible for contacting all parties involved in the claim, gathering, and securing all necessary information to effectively evaluate the claim and implement an action plan to manage the claim. The Claim Resolution Specialist 1 will work with and communicate to NJM policyholders, injured workers, medical providers,...

  • Claims Resolution Specialist

    3 days ago

    West Trenton, United States NJM Insurance Group Full time

    The Claim Resolution Specialist 1 will be responsible for contacting all parties involved in the claim, gathering, and securing all necessary information to effectively evaluate the claim and implement an action plan to manage the claim. The Claim Resolution Specialist 1 will work with and communicate to NJM policyholders, injured workers, medical providers,...

  • Claims Specialist

    2 months ago

    Trenton, United States Biogensys Full time

    Job DescriptionJob DescriptionWe are hiring a Claims Specialist (Worker's Compensation) for one of our clients in Trenton, NJ.Job Description:Under the direction of a supervisor, determines compensability of Workers Compensation claims filed by State government employees against the State of New Jersey. Oversees medical case management for assigned...

  • Claims Specialist

    4 weeks ago

    Trenton, United States Biogensys Full time

    Job DescriptionJob DescriptionWe are hiring a Claims Specialist (Worker's Compensation) for one of our clients in Trenton, NJ.Job Description:Under the direction of a supervisor, determines compensability of Workers Compensation claims filed by State government employees against the State of New Jersey. Oversees medical case management for assigned...

  • Claims Specialist

    4 weeks ago

    Trenton, United States Newkleo LLC Full time

    Under the direction of a supervisor, determines compensability of Workers Compensation claims filed by State government employees against the State of New Jersey. - Oversees medical case management for assigned files, and authorizes appropriate medical treatment in consultation with a managed care provider. - Processes temporary compensation payments, and...

  • Claims Specialist

    3 days ago

    Trenton, United States Newkleo LLC Full time

    Under the direction of a supervisor, determines compensability of Workers Compensation claims filed by State government employees against the State of New Jersey. - Oversees medical case management for assigned files, and authorizes appropriate medical treatment in consultation with a managed care provider. - Processes temporary compensation payments, and...

  • Claims Specialist

    4 weeks ago

    Trenton, United States Codinix Technologies Full time

    Under the direction of a supervisor, determines compensability of Workers Compensation claims filed by State government employees. Oversees medical case management for assigned files, and authorizes appropriate medical treatment in consultation with a managed care provider. Processes temporary compensation payments, and orders Independent Medical...

  • Claims Specialist

    23 hours ago

    Trenton, United States Codinix Technologies Full time

    Under the direction of a supervisor, determines compensability of Workers Compensation claims filed by State government employees. Oversees medical case management for assigned files, and authorizes appropriate medical treatment in consultation with a managed care provider. Processes temporary compensation payments, and orders Independent Medical...

  • Claims Specialist/ Worker's Compensation

    1 month ago

    Trenton, New Jersey, United States 22nd Century Technologies, Inc. Full time

    Job Title: Claims Specialist/ Worker's CompensationLocation: Trenton, NJ 08625Pay Rate: $28.00/hr. without benefitsDuration: 1+ months(With high possibility of extension)Work Schedule: 8:30 AM to 4:00 PM Lunch: 1/2 hour (unpaid)Job Description:Under the direction of a supervisor, determines compensability of Workers Compensation claims filed by State...

  • Claims Occupational Accident Adjuster

    1 month ago

    Trenton, United States Zurich Insurance Group Full time

    ** Claims Occupational Accident Adjuster (A&H), Specialist II** 73650 Zurich is currently looking for a Claims Occupational Accident Adjuster (A&H), Specialist II within the Accident and Health BU to work out of our Parsippany, NJ office. Zurich North Americas A&H program provides insurance coverage to help financially protect both the on-the-job independent...

  • Claims Occupational Accident Adjuster

    3 weeks ago

    Trenton, United States Zurich Insurance Group Full time

    ** Claims Occupational Accident Adjuster (A&H), Specialist II** 73650 Zurich is currently looking for a Claims Occupational Accident Adjuster (A&H), Specialist II within the Accident and Health BU to work out of our Parsippany, NJ office. Zurich North Americas A&H program provides insurance coverage to help financially protect both the on-the-job independent...

  • Claims Specialist

    2 months ago

    Trenton, United States Newkleo LLC Full time

    Under the direction of a supervisor, determines compensability of Workers Compensation claims filed by State government employees against the State of New Jersey. - Oversees medical case management for assigned files, and authorizes appropriate medical treatment in consultation with a managed care provider. - Processes temporary compensation payments, and...