Claims Processor

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $0 - $50k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

👻 Ghost score 0%

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Medlogix

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

💰 Private Equity Round on 2017-06

Healthcare • Consulting • Logistics

Medlogix is a company that specializes in providing comprehensive medical services, including workers' compensation, auto medical services, and group health services. They offer online referral systems and eBilling solutions to streamline the management of medical claims. With a focus on technology, Medlogix employs innovative platforms like MyMedlogix™ and MedlogixU™ to enhance their services and ensure exceptional client experiences.

📋 Description

• Review and process insurance claims by verifying policy coverage, gathering information, evaluating claim validity, and determining payout amounts based on policy terms • Ensure documentation is complete and accurate while adhering to company guidelines and regulations • Interact with policyholders, agents, and other stakeholders to facilitate the claims process • Maintain compliance with HIPAA confidentiality requirements • Support multiple departments, including litigation and legal departments • Conduct account searches and obtain police reports • Make initial contact and document files upon receipt of first notice of loss • Send appropriate claim forms to claimants, insureds, and representatives • Review files for proper reserves and document files • Request missing documentation needed to manage files • Support litigation/legal departments with disputes, appeals, and pre-suits • Support post-service appeals, assignments, dispute awards, settlements, and withdrawals • Make appropriate payments for awards, settlements, and applicable interest • Reroute documentation when a claim is not in the system • Conduct cycle-time file reviews for missing or pending documents, open billing, and file closure • Manage day-to-day operations to ensure client SLA-defined SOPs are followed

🎯 Requirements

• Bachelor’s degree or relevant experience required • Prior carrier or adjuster experience • Knowledge of New Jersey No Fault PIP regulation; 2–3 years preferred • Minimum 2 years medical billing or claims processing background • Excellent organizational skills and attention to detail • Interactions conducted with sensitivity, maturity and professionalism • Knowledge of claims systems and procedures • Excellent written and verbal communication skills • Ability to maintain confidential information • Comfortable in a high-volume, fast, team-oriented environment • Proficient in Microsoft Office Suite • Ability to work in multiple claim systems • Ability to follow SOPs as defined in clients’ SLAs • Full-time availability, Monday–Friday, 8:00 a.m.–4:30 p.m.