Senior Claims Processor, Auditor

🔥 0 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟠 Senior

📋 Claims Specialist

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Health Admins

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2015

💼 Consulting

🛡️ Insurance

📣 Marketing

Consulting • Insurance • Marketing

Health Admins is leading healthcare in a new direction by simplifying access to healthcare services and making them more affordable for members. Through their Smart Healthcare Platform, they provide TPA software, healthcare navigation, bill negotiation, and claims processing services. Their goal is to enhance member satisfaction and foster loyalty by offering powerful tools and personalized assistance to control costs and improve healthcare decisions.

📋 Description

• Review and process medical claims submitted by members or providers promptly and accurately • Verify the accuracy and completeness of necessary information, including patient demographics, diagnoses, procedures, and billing codes when available • Ensure compliance with insurance policies and industry standards • Investigate and resolve discrepancies or issues related to claims submissions • Conduct comprehensive medical claims audits to identify errors, discrepancies, or fraudulent activities • Analyze claims documentation, including medical records and billing statements, for adherence to coding guidelines and reimbursement policies • Research complex medical billing and coding issues to support claims processing and audit activities • Interpret coding guidelines, reimbursement policies, and legal requirements to determine appropriate claims adjudication • Recommend improvements to claims submission procedures and reimbursement accuracy • Serve as members' primary point of contact for claims inquiries and resolution • Respond to customer inquiries and concerns with professionalism and empathy • Collaborate with cross-functional teams to address customer issues and ensure timely resolution

🎯 Requirements

• High School Diploma or equivalent • Proven experience in medical claims processing, auditing, and healthcare reimbursement • Strong knowledge of medical terminology, medical coding, and insurance billing practices • Excellent analytical skills with the ability to interpret complex healthcare regulations and guidelines • Exceptional attention to detail and accuracy in data entry and documentation • Effective verbal and written communication skills with a customer-centric approach • Ability to work independently and collaboratively in a fast-paced, deadline-driven environment • Excellent verbal, written and interpersonal communication skills • Must be self-motivator and self-starter • Exceptional listening and analytical skills • Solid time management skills • Ability to multitask and successfully operate in a fast paced, team environment • Must adapt well to change and successfully set and adjust priorities as needed • Salesforce experience • Google Suite experience • Claims management software experience

🏖️ Benefits

• Competitive salary and benefits package • Opportunities for professional growth and development • Remote work