Claims Adjuster Trainee
Allstate
Senior Insurance Follow Up Specialist
Margie and Bill Klesse College of Engineering and Integrated Design at UTSA
full-time
Posted on:
Location Type: Remote
Location: Remote • Texas • 🇺🇸 United States
Visit company websiteJob Level
Senior
About the role
- Initiates insurance follow-up on unresolved appealed or unpaid claims to ensure maximum and timely reimbursement for Medicare, Medicaid, Commercial, or Specialty insurance/program payors, with a focus on complex insurance denials.
- Verify patient benefits and insurance eligibility, perform claims status verification, navigate through insurance websites for specific payor guidelines, and effectively communicate findings to insurance companies, management teams, and clinical departments.
- Assist the customer service team in resolving high-complexity and/or escalated patient billing concerns or disputes.
- Review and respond to insurance correspondence letters related to recoupments, refunds, eligibility, or additional requests from payors.
- Analyze daily claim rejections, screen claims for pre-authorization, and request and submit medical records.
- Work closely with the team to manage high-complexity work queues and claims. Lead special projects to fruition and help define and streamline workflows.
- Meet or exceed current production standards set by the management team to resolve outstanding claims and maintain healthy accounts receivable.
- Handle requests from the Coding, Payment Posting, Managed Care Operations, Provider Enrollment, and Clinical Operations Team to resolve claims and patient or provider issues.
- Serve as the liaison between affiliated hospitals and organizations to maximize collection efforts.
- Completes all other duties as assigned.
Requirements
- Knowledge of patient billing or collection/reimbursement procedures in a healthcare setting is preferred. Experience in medical claims follow-up functions specific to processing insurance claim appeals for various payors.
- Detail-oriented, with the ability to organize, prioritize, and coordinate work within schedule constraints and handle emergent requirements in a timely manner.
- Able to multi-task in a fast-paced, high-volume environment.
- Proficient in Microsoft Office software.
- Medical healthcare records software experience.
- Experian, Trizetto/Claim Logic experience.
- EDUCATION:
- High School Graduate or Equivalent
Benefits
- ONSITE TRAINING 4-6 weeks then fully Remote!
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
insurance follow-upclaims status verificationmedical records submissionclaims processinginsurance claim appealsbilling proceduresreimbursement procedurespre-authorization screeningpatient eligibility verificationclaims analysis
Soft skills
detail-orientedorganizational skillsprioritizationcoordinationmulti-taskingcommunicationproblem-solvingteam collaborationtime managementcustomer service
