Seeking a detail-oriented and analytical Claims Payment Adjuster to join our team. In this role, you will be responsible for reviewing, processing, analyzing and adjusting medical claims to ensure accuracy, compliance, and efficiency. You will work closely with other team members and cross functional teams such as configuration and Account Management to resolve discrepancies and improve claims processing workflows.
Key Responsibilities:
Process and analyze medical claims in accordance with company policies within all client service level agreements.
Consistently meet department quality and production standards.
Review claims for accuracy, completeness, and compliance with Medical Policy and client unique set up Identify and investigate claim discrepancies, denials, and errors, and take action to report issues internally.
Communicatewith other plans via the BlueSquared BCBSA Application Maintain up-to-date knowledge of processing and continue to increase skill set in order to handle more complex claim scenarios.
Provideinsights to improve claims processing efficiency. Collaborate with internal teams to enhance claims handling procedures.
Otherduties as assigned by Leadership Team
Qualifications & Skills:
Experience:3 years or more of experience in medical claims processing and adjusting or healthcare administration. Preferred experience with pre-existing condition reviews.
Technical Skills: Knowledge of medical billing codes (ICD-10, CPT, HCPCS), HealthRules, FOS, Salesforce and the BlueCard product.
Analytical Skills: Ability to assess claim data and identify errors or inefficiencies. Possess excellent mathematical skills and have the ability to work independently and within tight timeframes. Exposure to preexisting provisions is a plus
Communication Skills: Strong written and verbal communication skills for interacting with various stakeholders.
Attention to Detail: High level of accuracy and thoroughness in reviewing claims for client.
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
...Responsibilities ~ The Director of Pharmacy is responsible for organizing and supervising all aspects of daily pharmacy operations to ensure safe medication management processes throughout the hospital. Manages budgets for pharmacy staff and inventory. ~ Establishes...
...client in and out of bed or a wheelchair. ~ Ability to reach, bend, kneel, and stand for (sometimes) a long period of time. ~ Experience working with clients who have a form of paralysis. Schedule : Weekends (Saturday and Sunday) 8:00 a.m. - 4:00 p.m....
...Description Shape the Future of Fashion Events You'll lead our sales team to drive revenue growth across our Fashion portfolio. In... ...Qualifications Skills You'll Bring ~5+ years leading B2B sales teams with a track record of exceeding revenue targets ~...
...procedures+ Promote a team environment, assisting other drafters, designers, engineers with their projects+ Create background floor plans... ...timelines.**_Certification/Licensing (see below)_****_Fire Alarm Specific_**+ Have basic knowledge in current codes such as NFPA...
Position Overview: Now Hiring!: Re-Entry inspHire Program Career Coach Location: Tampa, FL Salary Range $22 - $24 per hour Benefits & Perks: ~19 Paid Holidays.~10 Additional Paid Days Off.~ Bi-Weekly Paid Healthcare Stipend. ~ The opportunity to...