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Healthcare Claims Specialist
2 months ago
EverStaff is seeking a qualified Medical Claims Adjuster to support our client in the healthcare sector. The successful candidate will be tasked with the assessment, investigation, and processing of medical claims to guarantee precise payment in accordance with policy stipulations.
Compensation- Salary Range: $50,000 - $65,000
- Comprehensive Medical, Dental, and Vision insurance
- 401K Retirement Plan
- Paid Time Off (PTO)
- Life Insurance Coverage
- Potential for Bonuses
- Profit Sharing Opportunities
- Assess and analyze medical claims for precision and thoroughness, ensuring adherence to policy terms, insurance laws, and organizational protocols.
- Conduct in-depth investigations of claims by collecting necessary medical documentation, invoices, and supporting materials. Evaluate medical reports and billing codes to ascertain coverage and liability.
- Decide on the suitable resolution or rejection of claims based on the investigation, policy coverage, and legal guidelines. Compile comprehensive reports and documentation to substantiate claim decisions.
- Engage effectively with policyholders, healthcare providers, and other relevant parties to gather information, clarify coverage decisions, and address any concerns related to the claims process.
- Guarantee that all claims are processed in compliance with state and federal laws, as well as company policies and procedures. Stay informed about industry developments and legal requirements.
- Meticulously document all claims activities, including notes on discussions, decisions, and follow-up actions. Maintain organized and secure records for each claim.
- Deliver outstanding customer service to policyholders and healthcare providers by addressing inquiries, resolving conflicts, and ensuring a positive experience throughout the claims process.
- Collaborate closely with the legal team, fraud investigators, and other departments as necessary to tackle complex claims, identify potential fraud, and ensure proper claim resolution.
- Bachelor's degree in a relevant field (e.g., healthcare, insurance, business) preferred, or equivalent professional experience.
- 2-4 years of experience in medical claims adjusting, insurance, or a related field.
- Familiarity with healthcare billing codes (ICD, CPT) and medical terminology is essential.
- Strong analytical and problem-solving capabilities
- Excellent written and verbal communication skills
- Proficient in MS Office (Word, Excel, Outlook) and claims processing software
- Attention to detail and accuracy
- Ability to work independently and collaboratively
- Strong organizational and time-management skills
All qualified applicants will receive consideration for employment without regard to race, color, religion, ethnicity, national origin, sex, gender identity, sexual orientation, disability status, protected veteran status or any other protected status under the law. EverStaff is an equal opportunity employer (M/F/D/V/SO/GI).
