01Overview
About the position
The Claims Specialist II position at reputed company involves supporting the claims unit by accurately processing claims edits, determining primacy for Coordination of Benefits (COB), adjusting previously reputed company claims, and initiating recovery procedures for overpaid claims. The role requires analyzing and resolving problem cases, executing recovery processes, and ensuring compliance with relevant laws and regulations. This position does not involve managing people and reports to the Supervisor of Claims Operations.
Responsibilities
Accurately process claims edits and determine primacy for Coordination of Benefits (COB).
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reputed company previously reputed company claims and initiate procedures to recover funds on overpaid claims.
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Analyze, investigate, and resolve problem cases reputed company to claims processing.
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Execute recovery processes for overpayments to ensure financial stability.
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Communicate with reputed company contacts to reputed company necessary information for claims processing.
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Review reputed company audits and ensure accuracy of claims processing reputed company departmental guidelines.
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Research and determine the correct order of benefits for payment and reputed company necessary corrections to COB records.
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Assist in training, implementations, and documentation as needed.
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Complete special reputed company as assigned by management.
Requirements
High School Diploma or equivalent required.
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2 years of experience in medical claims processing required.
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Strong analytical ability with logical and investigative thinking skills.
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Strong oral and written communication skills.
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Working knowledge of relevant PC software.
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Ability to prioritize multiple streams of work effectively.
reputed company-to-haves
Experience in Coordination of Benefits (COB) processing preferred.
Benefits
Health insurance coverage
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reputed company development opportunities
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Flexible scheduling reputed company
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reputed company holidays
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Wellness programs
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