ConnectiveRx

Claims Specialist

ConnectiveRx

full-time

Posted on:

Location Type: Office

Location: Whippany • New Jersey • 🇺🇸 United States

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Salary

💰 $18 - $23 per hour

Job Level

Junior

About the role

  • Verifies the accuracy and completeness of claim forms and attachments, such as EOBs, EOPs, SPPs, and pharmacy receipts.
  • Information is entered into adjudication systems as required.
  • Claims are paid or rejected based upon system adjudication and/or application of business rules external to the systems.
  • Consult with the Team Lead or Supervisor for complex claims or clarification of business rules.
  • Obtains missing information by calling or writing customers using standard scripts or form letters.
  • Based on volume, may also process claims and/or answer phones.
  • Refers to requests for escalation as needed and engages other internal areas such as Program Management, IT, and other Contact Center teams to resolve issues.
  • Provide input and feedback to the Supervisor, Quality Management, and Training (among others) to improve processes, procedures, and training.
  • Other projects and tasks as assigned.

Requirements

  • High School or GED required
  • 1+ years in a health care or case management setting
  • Experience working in pharmacy benefits, health care insurance, and/or medical billing a must
  • Knowledge of EOB and EOP statements
  • Prior experience in a high-volume processing setting (i.e., doctor’s office, claims processing department, etc.) a plus.
  • Experience with Third-Party systems (SelectRx, Pro-Care, FSV) (preferred)
  • Fluent in English/Spanish (a plus).
  • Knowledge of Medical Claims processing/billing coding
  • Communication skills: Uses writing effectively to create documents, uses correct spelling, grammar, and punctuation; Ability to convey written and verbal information in easy-to-understand language.
  • Customer Focus: High level of empathy and emotional intelligence; Focuses on the opportunity to service patients with a high level of empathy.
  • Detail Oriented: Achieves thoroughness and accuracy when accomplishing a task.
  • Adaptability: Adapts to a variety of situations easily and effectively navigates situations.
  • Problem Solve; Thinks critically, and problem-solves issues to resolution.
Benefits
  • Employees at ConnectiveRx can enroll in comprehensive benefit plans, including medical, dental, vision, life, and disability insurance.
  • Employees may also participate in the company's 401(k) plan.
  • ConnectiveRx provides paid time off (PTO) to non-exempt employees for vacations and personal leave.
  • Eligible non-exempt employees receive Sick Time Off (STO) in accordance with company policy.
  • Employees also receive eight standard company holidays and three floating holidays annually.

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard skills
medical billingclaims processingEOB knowledgeEOP knowledgepharmacy benefitsThird-Party systemsSelectRxPro-CareFSVmedical claims coding
Soft skills
communication skillscustomer focusdetail orientedadaptabilityproblem solvingempathyemotional intelligencewriting skillscritical thinkingverbal communication
Certifications
High School diplomaGED