Claim Resolution Specialist

Curative
Full time
Healthcare
United States
Hiring from: United States
Primary Responsibilities

  • Coordinate between departments to resolve member billing issues, including, but not limited to contacting providers and/or facilities to update insurance information and resolve billing discrepancies.
  • Research claims issues resulting in member balance billing
  • Responds to member billing inquiries through written correspondences and/or phone calls.
  • Handles sensitive member interactions.
  • Maintains timely, accurate documentation in the claims system for all appropriate transactions.
  • Reports problems, errors, and denial trends to management including PHI breaches.
  • Meets the performance goals established for the position in the areas of: efficiency, accuracy, quality, member and provider satisfaction.

Required Qualifications

  • High School Diploma / GED OR equivalent years of working experience
  • Must be 18 years of age OR older
  • 1+ year of healthcare billing and/or health plan experience.
  • A basic understanding PPO benefits

Preferred Qualifications

  • Healthcare / Insurance billing industry experience
  • Medical terminology acumen and experience
  • Billing experience and understands multiple billing requirements across various payers and states. Knowledge of billing in the state of Texas is a plus.
  • Experience working in the Google workspace (Gmail, sheets, docs).

Telecommuting Requirements

  • Ability to keep all company sensitive documents secure (if applicable)
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
  • Must live in a location that can receive an approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills

  • Ability to multi – task and to understand multiple products and multiple levels of benefits within each product
  • Previous work experience in a fast – paced environment requiring multi – tasking skills
  • Ability to resolve calls, avoiding escalated complaints
  • Ability to exhibit empathy and be courteous to callers
  • Ability to triage and handle escalated situations
  • Ability to work in a fast – paced environment
  • Ability to adapt to changes
  • Ability to work independently and as part of a team

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