Claims Processing Specialist

2 weeks ago


Norton, Virginia, United States Modivcare, Inc. Full time

Are you dedicated to enhancing the lives of others through your work? Do you thrive in a customer-centric environment? If so, this role could be ideal for you.

This position involves the oversight and administration of claims submitted by healthcare providers, ensuring all documentation is accurate and complete.

Key Responsibilities:

  • Examine incoming claims and associated documents for precision and thoroughness.
  • Input claim details and pertinent information into the claims management system.
  • Review organizational policies to assess coverage and validate claims.
  • Request missing information utilizing standard communication templates.
  • Implement established protocols to evaluate claim eligibility and process claims accordingly.
  • Engage with providers as necessary to obtain further information or clarify claim specifics.
  • Comply with departmental timelines, policies, and procedures in claims processing.
  • Report any suspected fraudulent claims to the Fraud, Waste, and Abuse (FWA) department.
  • Contribute to additional projects or responsibilities as needed.
Qualifications:
  • High School Diploma is required.
  • No prior experience is necessary.
  • Equivalent combinations of education and experience will be considered.
  • Meticulous attention to detail and strong data entry capabilities for precise claims processing.
  • Basic computer skills, including familiarity with Microsoft Office applications (Word, Excel, Outlook).
  • Analytical skills to interpret claim data and adhere to established protocols.
  • Strong verbal and written communication skills with a focus on customer service.
  • Problem-solving skills to address claim-related issues and resolve discrepancies.
  • Ability to work autonomously as well as collaboratively within a team.
Compensation: $16.70/hourly

Benefits:
Modivcare offers a comprehensive benefits package, including:
  • Medical, Dental, and Vision coverage
  • Employer-paid Basic Life Insurance and AD&D
  • Voluntary Life Insurance options
  • Flexible Spending Accounts for healthcare and dependent care
  • Commuter and parking benefits
  • 401(k) Retirement Savings Plan with company matching
  • Paid Time Off and Paid Parental Leave
  • Short-Term and Long-Term Disability coverage
  • Tuition Reimbursement
  • Employee Discounts on various services
Modivcare is an Equal Opportunity Employer, considering all applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, disability, or veteran status.

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