Claims manager Jobs in Hialeah fl

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Job Type

Full-time

Description

Provide claim processing services for members, doctors, and clients as provided by the company's various plans and programs. Positions are assigned either to an In-Network Claims unit that handles claims for doctors, or an Out-of-Network Claims unit that reimburses patients when they go to a different provider.

Essential Functions

Effectively and efficiently process claims ranging from routine to complex situations

Evaluate claim data to pay correct claim benefit amounts according to the company's plans and programs. This requires in-depth knowledge of the following areas :

• Plans, products, and services
• Processing transactions
• Policies and procedures for claim payment
• Accurate completion of necessary documentation, letters, and forms processing

Effectively maintain and support quality, productivity, and timeliness standards

Contact members or doctors as well as receive and respond to telephone calls as needed. Gathering information, processing claims, and written correspondence.

Requirements

Job Specifications

Typically has the following skills or abilities :

One to two years experience in a medical office, medical insurance provider, or related technical education with exposure to CPT, HCPCS, and ICD-10 codes.

General understanding of how medical claims forms and codes are used

Demonstrated ability to work independently with minimal supervision. Takes initiative to effectively carry out responsibilities

Familiarity with the terminology and nature of work performed in a medical claims unit

Skill to use multiple automated information systems to retrieve and verify data

Proficient in a Windows environment with word processing, spreadsheet application, and data entry

Effective written and verbal communication skills to include the ability to develop and respond clearly and accurately to inquiries

Preferred Skills

Experience managing claims in JIRA, or related software

Experience managing a shared inbox or fax number

Ability to manage daily audits of pre-payment claims

LI-HYBRID

The compensation range for the role is listed below. Applicable salary ranges may differ across markets. Actual pay will be determined based on experience and other job-related factors permitted by law. As a part of the compensation package, this role may include eligible bonuses and commissions. For more information regarding iCare benefits, please click here .

Salary Description

15 - $18