Claims processor • springfield ma
Sr Insurance Specialist - Commercial/Blue Cross.Note: The compensation range noted above represents the base salaries for all positions at a given grade across the health system.Typically, a new hi... Show more
Host Healthcare is an award-winning travel healthcare company with an immediate opening for this Sterile Processor position in Milton, MA.If you are interested in this position, please contact your... Show more
With a bachelor’s degree in Business from Missouri State University and a strong commitment to community involvement, I am proud to lead an agency that values teamwork, growth, and service.As a boa... Show more
Genalco is a leading supplier of construction equipment attachments and industrial products, serving contractors, municipalities, and service providers across New England.With a reputation built on... Show more
Hourly Job Description Text JOBS to 811DIG (811344) to connect with our hiring team today! Are you an outdoor enthusiast who enjoys independent field work and is looking to jump start your career? ... Show more
Alliance Risk Group, founded in 2005, is a leading provider of risk mitigation solutions.Work from your home office while conducting field investigations near your city.Collect and analyze evidence... Show more
Are you ready to take your career in the insurance industry to the next level? Do you have a passion for helping clients protect what matters most to them? If so, we have an exciting opportunity fo... Show more
Taking care of our customers, our communities and each other.By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 17... Show more
Job Title: Specimen Processor I.The Specimen Processor I plays a key role in the laboratory by performing specimen accessioning, sample sorting, and accurate data entry in a fast-paced, high-throug... Show more
Labcorp is a global leader in laboratory services, providing the insights and answers that help healthcare providers, patients, researchers, pharmaceutical companies and health systems make confide... Show more
NOW HIRING: REMOTE CUSTOMER SERVICE REPRESENTATIVES.Work From Home Multiple Shifts Available Healthcare, Insurance & Claims Experience Preferred.Looking for a stable remote opportunity with a respe... Show more
Hospice Business Office Coordinator.Harmony Hospice is seeking a highly organized, detail-oriented, and proactive.This position plays an important role in office management, payroll processing, bil... Show more
As an Institutional Insurance Investment Product Analyst, you will combine investment product expertise with quantitative analysis to support the performance, oversight, and ongoing administration ... Show more
Implement and update PVTA's Claims policies and procedures: Maintain and develop professional knowledge of all regulatory requirements and internal procedures; evaluate all department processes/pro... Show more
Commercial Senior Account Manager/ Account Executive- Future Opportunities.May vary based on business need.Construction, Transportation, Condo/ Habitational.Senior Account Manager/ Account Executiv... Show more
The Sorter/Processor will perform a variety of tasks to assist in the operation of the sorting room.Process and sort donations by inspecting and separating saleable from unsaleable items.Ensure clo... Show more
East Longmeadow, MA, United States.Come make the world and accelerate your success.It takes great people to achieve greatness.People with a sense of purpose and integrity.People with a relentless p... Show more
Under limited supervision, investigate and resolve first and third party material damage, PIP, BI, and Third party Property claims which may involve coverage, liability, damage and legal issues.Eff... Show more
Note : This is an educational program, not a job.Successful completion of the program does not guarantee employment but will equip you with valuable skills for the healthcare job market.Looking to ... Show more
The research teams behind the best-known AI models come to Mercor for biotechnology judgment they can't generate on their own.Your standards and expertise become the rubric that frontier AI is grad... Show more
The average salary range is between $ 30,047 and $ 46,801 year , with the average salary hovering around $ 35,100 year .
Sr Insurance Specialist - Commercial/Blue Cross
Disclaimer for Job Postings
Note: The compensation range noted above represents the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range.
Holyoke Medical Center is looking for a Sr Insurance Specialist. This position manages complex medical claims, acting as a subject matter expert to investigate, adjudicate negotiate settlements, ensure compliance and mentor junior staff, focusing on accurate and timely and cost-effective claims resolution while maintaining strong communication with providers, payers and internal teams. Works all claims as assigned/directed.
DUTIES AND RESPONSIBILITIES:
Serve as subject matter expert, providing guidance on policy, regulations and complex claims scenarios.
Conduct in-depth analysis, research discrepancies, prevent fraud and develop plans for claims resolution.
Handles escalated inquires, build relationships with providers/payers and communicate claims status.
Assist in training, coaching and provide senior support to less experienced team members.
Review and process complex hospital claims and determine coverage based on policy, medical necessity and contracts.
Able to work all aspects of Commercial Managed Care, Medicare Advantage, and Medicaid Advantage Care accounts sliding between Financial Classes as needed for Billing, Follow-up, Denials Management, Credit Balance and Account resolution.
Required Skills
Must show honesty, integrity, strong ethics, data entry skills and time management skills
Insurance follow up experience especially Blue Cross and all Commercial Lines
Strong understanding of Medetech and finThrive billing programs
Strong Verbal and written skills for preparing and presenting appeals, negotiating settlements and presenting reports to Senior Management.
Proactive approach to resolving discrepancies between insurance policy terms and provider charges
Ability to analyze complex data, identify issues and solve problems
Proven background in handling complex institutional or healthcare related claims
Proficiency with claims software and MS Office (especially Excel).
Strong time management, organization skills and ability to work independently or in a team
Good plus knowledge of ICS/HCPCS/CPT Coding and medical terminology
Knowledge of commercial, state and federal healthcare regulations
Excellent Math Skills and knowledge of general accounting principals
Ability to logically and accurately organize data
Excellent problem solving skills
Strong attention to detail
QUALIFICATIONS/JOB REQUISITES:
Education: High School Diploma or GED is required, an Associate or Bachelor’s degree in Health Administration or related Study preferred
Experience: Eight plus (8+) years in the health insurance, hospital business office or claims processing/management.
PI249aecf97a4f-30511-41696114
