Claims Examiner

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🔥 9 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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Dayforce

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

👥 HR Tech

☁️ SaaS

🏢 Enterprise

💰 $1G Post-IPO Debt - Dayforce on 2024-03

HR Tech • SaaS • Enterprise

Dayforce is a cloud-based human capital management (HCM) platform that delivers integrated payroll, HR, workforce management, talent management, and benefits administration for employers. It is offered as a software-as-a-service (SaaS) solution designed to help organizations manage employee lifecycle processes, payroll and scheduling in a unified system.

📋 Description

• Manage and handle all Outbound calls and adjudicate claims. • Adjudicating HP/AD claims. • Handling all Outbound calls. • Should be able to prioritize work and adjudicate claims as per turnaround time. • Job involves working independently on researching, reviewing, summarizing, and recommending a course of action on claims where an appeal or a grievance has been filed for a denied / under payment. • Should have strong English comprehension, mathematics & medical science knowledge to comprehend medical reports. • To ensure claims are adjudicated as per the client/company guidelines. Provide continual evaluation of processes and procedures. • To respond to and resolves claims received via emails. • Candidate should be able to correctly calculate claim amounts for the customers. • Complying with company regulations regarding HIPAA, confidentiality, and private health information.

🎯 Requirements

• Experience in handling US HIP claims • Should have knowledge of ICD 10, CPT, Surgery procedures, Revenue codes, medical terminology, medical documents, Inpatient vs Outpatient claims etc. • Should have some experience in reading and comprehending medical documents.

🏖️ Benefits

• Collaborative team spirit. • Accountable and able to work remotely and independently. • Able to pass background screening and drug tests pre and post hire – includes THC. • Verification of high school, GED, or college diploma upon request. • Timely responses from three professional references. • Able to provide a dedicated remote work location free from background noises, interruptions, and desk clutter. • Able to provide an ongoing reliable internet connection and access to a smart phone for Multi Factor Authentication and communication purposes.