REMOTE: Claims Specialist

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Written by AI from the job title and company, not by Evry Health, so some details may not match this job. The employer's own page has the real description.

Job Overview

The Claims Specialist at Evry Health will be responsible for reviewing, processing, and adjudicating claims in accordance with established policies and regulations. This role demands a high degree of accuracy and attention to detail while ensuring compliance with health care laws and guidelines. The ideal candidate will work remotely to liaise with various stakeholders to resolve discrepancies, enhance claims processing efficiency, and ensure a smooth experience for our members and providers. This position is integral to maintaining the integrity of our claims management and customer satisfaction.

Job Responsibilities

• Review and evaluate insurance claims in a timely and accurate manner.
• Investigate claims discrepancies and resolve problems in collaboration with providers, members, and internal departments.
• Ensure all claims processing guidelines are adhered to according to federal regulations and company policies.
• Maintain accurate records and documentation for all claims processed.
• Assist in training new team members on claims processing techniques and software.
• Actively participate in process improvement initiatives to enhance overall claims efficiency.
• Respond to inquiries regarding claims status and eligibility from members and providers.

Qualifications

• Bachelor's degree in a related field or equivalent work experience.
• Minimum of 2 years of experience in claims processing or a similar role within the healthcare industry.
• Strong understanding of healthcare claims processing rules and regulations.
• Exceptional analytical and problem-solving skills.
• Proficiency in using claims processing software and Microsoft Office Suite.
• Excellent written and verbal communication skills.
• A positive and proactive approach to customer service and teamwork.

Technologies & Tools

The Claims Specialist will utilize various software and systems specific to claims management, including proprietary healthcare claims processing software and electronic health records (EHR) systems. Proficiency in Microsoft Office Applications, particularly Excel and Word, is essential for documentation and reporting tasks. Familiarity with medical coding and billing systems will also be advantageous for accurately processing claims.

Ideal Candidates

Ideal candidates for the Claims Specialist position at Evry Health will demonstrate a meticulous attention to detail and possess a strong sense of responsibility in their work. They should have the ability to think critically and approach challenges with a solutions-oriented mindset. Strong interpersonal skills are essential for effective communication with colleagues and clients alike. Additionally, candidates who show a commitment to continuous learning and adaptability in a changing environment will thrive in this role.