Remote claims policy & procedure specialist - united states, minneapolis

adecco is currently assisting a local client in their search to fill a remote claims policy & procedure specialist position

 

100% remote

length: 5+ months

pay: $35.00 /hr

shift/hours: monday – friday 9am – 5pm est

 

job duties:

participate in the implementation and management of claim operational strategies, policies, workflow processes and standards and ensure effective utilization of them.

function as a liaison to service vendors and business partners to align service delivery with strategic objectives and priorities; assist in handling escalated service issues

assist with the management of the claim processing team by handling escalated claims processing and benefit configuration questions

assist with the management of complex claims issues such as coordination of benefits and adjustments

assist with the management of complex overpayments and refund processes including auto recoupment of overpayments

assist with the management of the prior authorization process with network partners

participate in the development of the claims organizational structure. assist with training claims examiners on the unique bind plan design

assist with testing and auditing benefit setup and enhancements in the claims adjudication system.

perform special projects as defined by leader
 

what skills/attributes are required:

a minimum of five (5) years of medical claims experience

previous claims processing experience

quick decision maker

experience in automating and/or re-engineering manual claim processes

claim technology expertise and workflow management including electronic claim files and carc/rarc mapping

exceptional communication skills

 

important: this remote claims policy & procedure specialist job is being recruited for by adecco’s national recruitment center, not your local adecco branch office. to be considered for this position, you must use the “apply with adecco” button to submit your

equal opportunity employer/veterans/disabled



the company will consider qualified applicants with arrest and conviction records

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