SPE-Claims HC

Job Summary

We are seeking a skilled SPE-Claims HC professional with 1 to 3 years of experience in Claims Adjudication. The ideal candidate will work from our office during night shifts contributing to our mission of delivering efficient claims processing. This role does not require travel and offers an opportunity to make a significant impact in the healthcare claims domain.

Responsibilities

• Analyze and process healthcare claims efficiently to ensure timely adjudication and payment.
• Collaborate with team members to resolve complex claims issues and discrepancies.
• Utilize technical skills in claims adjudication to enhance processing accuracy and efficiency.
• Monitor claims processing workflows to identify areas for improvement and implement solutions.
• Provide support and guidance to team members on claims adjudication processes.
• Ensure compliance with company policies and regulatory requirements in all claims processing activities.
• Maintain accurate records of claims processing activities and outcomes.
• Communicate effectively with internal and external stakeholders to resolve claims-related inquiries.
• Participate in training sessions to stay updated on industry trends and best practices.
• Contribute to the development of process improvement initiatives to enhance claims processing efficiency.
• Assist in the preparation of reports and documentation related to claims processing activities.
• Support the implementation of new systems and technologies to improve claims adjudication processes.
• Foster a collaborative work environment to achieve team goals and objectives.
  
  

Qualifications

• Demonstrate expertise in claims adjudication with a strong understanding of healthcare claims processes.
• Possess excellent analytical skills to identify and resolve claims issues effectively.
• Exhibit strong communication skills to interact with team members and stakeholders.
• Show proficiency in using claims processing software and tools.
• Have a keen eye for detail to ensure accuracy in claims processing.
• Display the ability to work independently and as part of a team.
  
  

Certifications Required

Certified Professional Coder (CPC) or equivalent certification in claims adjudication.