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Insurance Claims Coordinator
2 months ago
The primary role of a Benefits Coordination Specialist is to facilitate the coordination of benefits between Doctors Healthcare Plans, Inc. and various insurance providers that may be responsible for the services rendered to our members.
Key Responsibilities:
- Evaluate, process, investigate, and resolve claims involving additional insurance carriers.
- Manage and oversee COB claims in accordance with CMS regulations.
- Conduct outreach to members regarding other insurance coverage through phone communications and written correspondence, including claim adjustments and appeals.
- Oversee the distribution and follow-up of questionnaires and letters sent to members and healthcare providers.
- Ensure timely processing of COB claims.
- Uphold quality standards in all research and adjustment activities.
- Input claims or verify data entry for precision and thoroughness.
- Utilize online policies and procedures to guarantee accuracy in claims processing.
- Act as a liaison for providers and members regarding specialized claims handling.
- Contribute to team success by achieving related outcomes as necessary.
- Communicate effectively with other professionals and support staff to ensure positive customer experiences.
- Foster and promote a constructive, problem-solving atmosphere.
- Adhere to company policies and procedures while maintaining the confidentiality of customer medical records in compliance with state and federal regulations.
- Ensure adherence to all HIPAA, OSHA, and other applicable federal, state, and local laws.
- Participate in meetings, training sessions, and in-service education as required.
- Perform additional duties as assigned.
- Strong oral and written communication abilities.
- 1 - 3 years of experience in health claims processing.
- Familiarity with COB and MSP is preferred.
- Understanding of medical terminology.
- Knowledge of current Medicare Advantage operational and regulatory guidelines established by CMS, AHCA, and other relevant federal and state regulations.
- Exceptional organizational skills.
- Ability to perform well under pressure in challenging situations.
- Bilingual: English / Spanish (Required).
Note: This description provides a general overview of the type and level of work performed and responsibilities held by team members. Duties described are not exhaustive or specific to any individual team member.
Our company is dedicated to fostering a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Opportunities posted here do not create any implied or express employment contract between you and our company or our clients and can be modified at our discretion and/or the discretion of our clients. Any and all information may change without notice. We reserve the right to determine applicant suitability solely.
