Senior Claims Benefit Specialist - Remote - Remote Eligible

✨ About The Role

- The Senior Claims Benefit Specialist will review and adjudicate complex claims in accordance with processing guidelines. - This role involves acting as a subject matter expert, providing training and coaching to other claim benefit specialists. - The specialist will handle phone and written inquiries related to pre-approval, reconsiderations, or appeals. - Compliance with company practices and procedures is crucial, ensuring all claims are processed correctly. - The position includes identifying and reporting claim irregularities, such as overpayments and underpayments.

⚡ Requirements

- The ideal candidate will have at least 2 years of medical claim processing experience, demonstrating a solid understanding of the claims adjudication process. - Experience in a production or metrics-based environment is essential, showcasing the ability to manage multiple assignments efficiently. - A strong attention to detail is necessary to accurately apply medical necessity guidelines and determine coverage for claims. - The candidate should possess excellent communication skills to handle customer service inquiries and provide training to junior staff. - A high school diploma is required, with a preference for candidates holding an associate's degree or equivalent work experience.