Benefit Claims Specialist

4 days ago


Glen Allen, Virginia, United States Amtex Systems Inc Full time
Job Opportunity

Job Title: Benefit Claims Analyst and Adjudicator

Location: Remote

Employment Type: 6 months Contract to Hire

Job Summary:

We are seeking a skilled Benefit Claims Analyst and Adjudicator to support our PBM client. The successful candidate will process, review, and adjudicate benefit claims using the Cervey platform, ensuring accurate and timely claim payments while providing exceptional customer service.

Key Responsibilities:

  • Process benefit claims accurately and efficiently using Cervey software
  • Review and verify claim documentation for completeness and accuracy
  • Adjudicate claims based on established criteria and guidelines
  • Research and resolve claim discrepancies or issues
  • Communicate effectively with clients, members, and providers to address claim inquiries
  • Adhere to strict compliance regulations and quality standards
  • Assist in identifying and implementing process improvements
  • Maintain up-to-date knowledge of benefit plans, policies, and procedures

Requirements:

  • Bachelor's degree or equivalent experience
  • Experience processing benefit claims and claim adjudication
  • Proficiency in Cervey software is mandatory
  • Strong analytical and problem-solving skills
  • Excellent attention to detail and accuracy
  • Excellent written and verbal communication skills
  • Ability to work independently and as part of a team

About Amtex Systems Inc:

Amtex Systems Inc is a leading provider of innovative solutions for the healthcare industry. We are committed to delivering exceptional service and support to our clients and members.



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