Claims Specialist

  • location: Tampa, FL
  • type: Contract
  • salary: $17 per hour
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job description

Claims Specialist

job summary:
Job Description:

Efficiently and accurately conducts the intake of all incoming documents including but not limited to Member and Provider Appeals as well as re-routing Grievances Pharmacy Claims Correspondence. etc.. and related requests Determines appropriate classification of each request performs research and accurate data entry as well as conducts initial processing and assignment of the requests.

Performs duties related to root cause analysis of escalated issues involving member and provider Appeals.

Key Duties and Responsibilities:

  • Utilizes multiple systems to gather information conduct research different data sources including Xcelys
  • WC Toolbox Application Extender Emma Appeals Tracker assess the situation and enter data.
  • Needs to access and interpret claim appeal correspondence and authorization data
  • Perform detailed root cause analysis to determine core issue related to member and/or provider complaint error or inquiry
  • Conducts intake and appropriate classification of Appeals Grievances Pharmacy and Claims Correspondence etc. requests and makes accurate judgment on appeal grievance claim disputes
  • medical records or other issues and follows procedures on how to handle each type of request and route to the appropriate area within the enterprise
  • Electronically enters claim detail information in organization applications including Sidewinder
  • Peradigm databases or specified work flow tool and documents receipt. disposition and other noteworthy aspects of the cases in the application
  • Evaluates data input and output for accuracy and ensures compliance with data integrity and corporate compliance directives
  • Completes data entry of all enterprise requests in an environment where compliance and accuracy are critical
  • Ensures timely processing and review of documentation to meet departmental goals and state specific benchmarks for timeliness
Minimum Qualifications:

  • Education: A High School or GED Required
  • Work Experience: 1+ year of experience in a Claims Customer Service Appeals Pharmacy Front End Configuration or Enrollment Data Capture role preferably in a health services environment.
  • Microsoft Word Beginner Required---Microsoft Excel Beginner Required
  • Microsoft Outlook Beginner Required
 
location: Tampa, Florida
job type: Contract
work hours: 8 to 5
education: High School
experience: 1 Years
 
responsibilities:
Job Description:

Efficiently and accurately conducts the intake of all incoming documents including but not limited to Member and Provider Appeals as well as re-routing Grievances Pharmacy Claims Correspondence. etc.. and related requests Determines appropriate classification of each request performs research and accurate data entry as well as conducts initial processing and assignment of the requests.

Performs duties related to root cause analysis of escalated issues involving member and provider Appeals.

Key Duties and Responsibilities:

  • Utilizes multiple systems to gather information conduct research different data sources including Xcelys
  • WC Toolbox Application Extender Emma Appeals Tracker assess the situation and enter data.
  • Needs to access and interpret claim appeal correspondence and authorization data
  • Perform detailed root cause analysis to determine core issue related to member and/or provider complaint error or inquiry
  • Conducts intake and appropriate classification of Appeals Grievances Pharmacy and Claims Correspondence etc. requests and makes accurate judgment on appeal grievance claim disputes
  • medical records or other issues and follows procedures on how to handle each type of request and route to the appropriate area within the enterprise
  • Electronically enters claim detail information in organization applications including Sidewinder
  • Peradigm databases or specified work flow tool and documents receipt. disposition and other noteworthy aspects of the cases in the application
  • Evaluates data input and output for accuracy and ensures compliance with data integrity and corporate compliance directives
  • Completes data entry of all enterprise requests in an environment where compliance and accuracy are critical
  • Ensures timely processing and review of documentation to meet departmental goals and state specific benchmarks for timeliness
Minimum Qualifications:

  • Education: A High School or GED Required
  • Work Experience: 1+ year of experience in a Claims Customer Service Appeals Pharmacy Front End Configuration or Enrollment Data Capture role preferably in a health services environment.
  • Microsoft Word Beginner Required---Microsoft Excel Beginner Required
  • Microsoft Outlook Beginner Required
 
qualifications:
Job Description:

Efficiently and accurately conducts the intake of all incoming documents including but not limited to Member and Provider Appeals as well as re-routing Grievances Pharmacy Claims Correspondence. etc.. and related requests Determines appropriate classification of each request performs research and accurate data entry as well as conducts initial processing and assignment of the requests.

Performs duties related to root cause analysis of escalated issues involving member and provider Appeals.

Key Duties and Responsibilities:

  • Utilizes multiple systems to gather information conduct research different data sources including Xcelys
  • WC Toolbox Application Extender Emma Appeals Tracker assess the situation and enter data.
  • Needs to access and interpret claim appeal correspondence and authorization data
  • Perform detailed root cause analysis to determine core issue related to member and/or provider complaint error or inquiry
  • Conducts intake and appropriate classification of Appeals Grievances Pharmacy and Claims Correspondence etc. requests and makes accurate judgment on appeal grievance claim disputes
  • medical records or other issues and follows procedures on how to handle each type of request and route to the appropriate area within the enterprise
  • Electronically enters claim detail information in organization applications including Sidewinder
  • Peradigm databases or specified work flow tool and documents receipt. disposition and other noteworthy aspects of the cases in the application
  • Evaluates data input and output for accuracy and ensures compliance with data integrity and corporate compliance directives
  • Completes data entry of all enterprise requests in an environment where compliance and accuracy are critical
  • Ensures timely processing and review of documentation to meet departmental goals and state specific benchmarks for timeliness
Minimum Qualifications:

  • Education: A High School or GED Required
  • Work Experience: 1+ year of experience in a Claims Customer Service Appeals Pharmacy Front End Configuration or Enrollment Data Capture role preferably in a health services environment.
  • Microsoft Word Beginner Required---Microsoft Excel Beginner Required
  • Microsoft Outlook Beginner Required
 
skills: MS Office
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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