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Medical Claims Examiner

2 months ago

Bethlehem, Pennsylvania, United States myHR Partner Full time
About the Role

We are seeking a highly skilled Claims Adjudicator to join our team at AblePay Health. As a Claims Adjudicator, you will play a critical role in ensuring the accuracy and integrity of claims received from billing providers.

Key Responsibilities
  • Process electronic and paper claims on a daily basis, verifying and reviewing claims for accuracy before adjudication.
  • Resolve claim discrepancies in a timely manner, working closely with billing providers to correct AblePay Member ID and insurance information.
  • Establish and maintain strong relationships with billing providers, members, and internal staff, providing exceptional customer service and support.
  • Assist members with general billing questions and resolve disputes/issues as authorized.
  • Negotiate discounts/savings with medical providers on out-of-network claims.
Requirements
  • Bachelor's degree and/or 2-3 years of medical billing experience.
  • Strong research and analytical skills, with the ability to work independently and escalate for assistance as needed.
  • Excellent communication and organizational skills, with the ability to work with various internal and external parties to resolve member issues.
  • Ability to proactively identify payer and provider trends, and communicate this to management.
  • Excellent listening skills and ability to empathize with members.
  • Excellent computer skills and experience in the Microsoft Office Suite.
What We Offer

We are proud to offer a comprehensive benefit package, including medical, HRA, dental, 401K, PTO, and paid parking. If you are a motivated and detail-oriented individual who is passionate about delivering exceptional customer service, we encourage you to apply for this exciting opportunity.