This is a Claim Benefit Specialist work-from-home opportunity for candidates in the CST and PST time zones.
- Reviews and adjudicates routine claims in accordance with claim processing guidelines.
- Analyzes and approves routine claims that cannot be auto adjudicated.
- Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
- Routes and triages complex claims to Senior Claim Benefits Specialist.
- Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.
- Experience in a production environment.
- Medical claim processing experience preferred but not required.
- Medical coding background a plus but is not required.
- Ability to work independently.
- Ability to think logically and problem solve.
- Strong oral communication skill.
- Computer knowledge with experience with Outlook, EXCEL and Word
- High School diploma, G.E.D. or equivalent experience.
Locations: ND, SD, NE, KS, OK, TX, MN, IA, MO, AR, LA, WI, IL, KY, MS, AL, WA, OR, CA, NV