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LISTING: HMO Medical Claims Examiners Needed (Remote Work From Home Positions)

5 Experienced Temporary F/T HMO Medical Claims Examiners Needed (Remote Work From Home Positions)

These are all remote work from home temporary full-time HMO Medical Claims Examiner Positions working Monday-Friday from (7:30am to 4:00pm) daily with a 30-minute lunch break.

You will be responsible for processing 100% HMO Medical Claims for payment within a timely manner with a minimum 98% accuracy rate.

You will be expected to process at least 140 medical claims per day utilizing the EZ-CAP Software.  

Job Responsibilities

  • Process 140 HMO medical claims per day with a high level of accuracy.
  • Analyze claims and approve or deny payment. Provide expertise on claims processing issues to co-workers and management.
  • Approve or deny claims for payment by ensuring the payment is correct, verifying the proper authorizations were submitted, and resolving any system hold codes.
  • Resolve reoccurring provider or member issues by identifying trends and recommending solutions to management.
  • Capture COB savings by coordinating payments of claims between insurance companies when more than one insurance company is involved.
  • Resolve claims issues received from the Customer Services department by researching claim situations and providing timely responses.
  • Ensure the completeness and accuracy of Standard operating procedures by providing feedback to the department manager on procedures that require documentation or additional detail.
  • Contribute to team effort by accomplishing the related goals and results as determined by the Claim Manager.
  • Maintain all necessary levels of member/patient privacy in accordance with HIPAA standards.

 

QUALIFICATIONS:

  • Associate’s degree or equivalent experience required
  • At least 2-3 years of relevant professional experience, including claims processing
  • Knowledge of claims and processes in Commercial, Medicare, and Medicaid health plan/TPA
  • Extensive knowledge of CPT 4, HCPCS and ICD-10 coding and Medical terminology
  • Proficient in MS Office Applications and ability to learn department and job specific software systems.
  • Demonstrate high attention to detail and a high degree of accuracy

 

All applicants are required to complete an online skills assessment exam within 24 hours of receiving the online assessment link.  

 

If you or anyone you know is interested, qualified and immediately available please e-mail an updated resume to us for immediate review and consideration.

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(This job listing is assigned to be sent to: Elizabeth.)

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