GuideWell Source

Compensation

Full Description

Job Description: • Day-to-day processing of claims for accounts: • Responsible for processing of claims (medical, dental, vision, and mental health claims) • Claims processing and adjudication. • Claims research where applicable. • Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic). • Incumbents are expected to meet and/or exceed qualitative and quantitative production standards. • Investigation and overpayment administration: • Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers. • Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records. • Utilize systems to track complaints and resolutions. • Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading. Requirements: • 2+ years related work experience. • Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry. • High school diploma or GED • Knowledge of CPT and ICD-9 coding required. • Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits required. • Must possess proven judgment, decision-making skills and the ability to analyze. • Ability to learn quickly and multitask. • Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers. • Concise written and verbal communication skills required, including the ability to handle conflict. • Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding. • Review of multiple surgical procedures and establishment of reasonable and customary fees. Benefits: • Medical, dental, vision, life and global travel health insurance • Income protection benefits: life insurance, Short- and long-term disability programs • Leave programs to support personal circumstances. • Retirement Savings Plan includes employer contribution and employer match • Paid time off, volunteer time off, and 11 holidays • Additional voluntary benefits available and a comprehensive wellness program