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Insurance Claims Specialist
2 months ago
Worldwide Insurance Services is seeking a dedicated Insurance Claims Specialist to become an integral part of our team. The Insurance Claims Specialist is responsible for evaluating and processing requests and inquiries related to adjustments in medical insurance claims, ensuring accuracy and timeliness while complying with established claims processing standards and Service Level Agreements.
Key Responsibilities:
- Conduct retrospective claim adjustments as required by internal departments.
- Demonstrate proficiency with the company's SalesForce application and effective communication practices.
- Engage with the Federal Employee Program (FEP) as necessary.
- Effectively communicate findings from claim adjustment analyses to relevant departments.
- Identify and report error trends for future training and educational purposes.
- Maintain departmental production and quality standards.
- Keep management informed of workload status and seek assistance when necessary.
- Adhere to regulations and company policies as outlined in the Employee Handbook.
- Perform additional duties as assigned.
Qualifications:
- High school diploma or equivalent is required; additional college education is a plus.
- A minimum of three years of experience in the health insurance sector, focusing on the examination and adjudication of medical claims.
- Familiarity with insurance products and terminology, including CPT and ICD-9 coding; coding certification is preferred for FEP (CPC, CCS).
- Proficient in using automated claims adjudication software.
- Strong verbal and written communication skills, with the ability to address customer complaints effectively.
- Excellent organizational, problem-solving, and basic mathematical skills.
- Ability to make informed decisions supported by documentation.
- Knowledge of Microsoft Office Products and internal software systems; familiarity with personal computers is essential.
- Salesforce experience is advantageous.
- Must have a minimum internet speed of 75 Mbps for remote work capabilities.
Working Environment:
- Flexibility to work in both office and remote settings.
- Occasional overtime and schedule flexibility may be required for key business meetings or critical job functions.
- Physical demands include effective communication through auditory and visual methods.
We offer a competitive base salary starting at $48,317 annually, with compensation determined by relevant experience and skill level.
This job description outlines essential functions and does not restrict the tasks that may be assigned.
