Sutherland

Health Claims Specialist

Sutherland

full-time

Posted on:

Origin:  • 🇺🇸 United States

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Job Level

Mid-LevelSenior

About the role

  • This is a full-time permanent healthcare claims adjudicator position.
  • A claims adjudicator determines how much money will be paid after an insurance claim has been examined.
  • This is not a customer service or customer facing position.
  • This is a data entry position where you will be processing medical claims per the specific client requirements.
  • Claims can vary and are highly customized depending on the service level.
  • You will work independently with the assistance of knowledge base and support personnel.
  • You will also be expected to meet all Key Performance Indicators and Quality goals throughout Training and beyond.
  • Work independently, processing claims via data entry for 90% of your day.
  • Be responsible for effectively adjudicating claims to meet production, quality, and other metrics in accordance with policy/procedures and regulatory guidelines
  • Follow up on claims needing additional information
  • Refer problem claims to a Lead and/or auditor for additional review
  • Make sure that the integrity of the information is accurate and kept private according to HIPPA guidelines
  • Work with specific software
  • May be assigned special projects
  • Weekday schedule, Monday – Friday 8:30 AM – 5:00 PM EST.

Requirements

  • Data entry
  • Time management
  • Attention to detail
  • Analytical
  • High School Diploma or equivalent
  • Excellent Internet Connectivity: Internet access speed of 2 Mbps upload and 10 Mbps download – the faster the better.
  • house network, and a hard-wired internet connection capable of continuously supporting outstanding call quality and high-speed response rates. (Wireless and/or satellite Internet Service Providers are not compatible with our systems)
  • A quiet and distraction-free, secure place to work
  • Effective verbal and written communication skills
  • Strong typing and analytical abilities
  • Multi-tasking skills with a strong attention to detail
  • Computer knowledge
  • Minimum 40 words per minute on typing test
  • Must have and maintain a clean and paper free work environment to meet our company policies.
  • Medical Billing and Coding degree/certification.
  • Previous experience in a medical office type setting, including some knowledge of insurance, claims, billing or coding, with an understanding of the different types of insurance (Medicare/Medicaid and/or Child Plus).
  • Knowledge of Medical terminology