Claims Representative

Job Description

Job Description

6-Month Contract FULLY REMOTE Opportunity with possible extensions

Shift :  Monday-Friday (9am-5 : 30 EST)

Day to Day :

A client in the Tampa, FL area is looking for a Claims Representative to join their team for a 6-month contract opportunity . This candidate will be responsible for researching, identifying, and obtaining data / information needed to help process claims or resolve claims issues. They’ll be applying appropriate processes and procedures to process claims. Lastly, they’ll create claims for members according to plan design and identify eligibility criteria of claim documentation. The team consists of 11 members currently. The ideal candidate should be organized, equipped to navigate office applications and software tools, and manage constant change in progress. Be self-directed, self-motivated, and a critical thinker.

Must Haves :

• 1-2 years of experience as a Claims Representative
• Researching, adjusting, processing claims
• High school GED
• Microsoft application experience (Outlook, Teams, etc)

Additional Experience :

Processing of Notional account claims.

Providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing, and adjusting claims.

Research regarding eligibility.

Authorizes the appropriate payment or refers claims to investigators for further review.

Conducts data entry and re-work; analyzes and identifies trends and provides reports, as necessary.