Claims Assistant - Medical Claims

Position Summary:

The Claims Assistant is a detail-oriented and organized individual. This role is responsible for administrative functions to support efficient and accurate processing of insurance claims while ensuring compliance with company policies and regulatory requirements. This role requires a strong understanding of healthcare claims processes, and the ability to effectively communicate with clients, management, and other teams within the organization.

Responsibilities:

Communication: Correspond with clients, providers, vendors, claims team, and other relevant parties to gather necessary information, clarify details, and provide updates on claim status.

Compliance: Ensure compliance with company policies, industry regulations, and legal requirements throughout the claims processing workflow.

Reporting: Generate reports and statistics on claim processing activities, trends, and outcomes to support claims department, management decision-making and performance evaluation.

Customer Service: Provide courteous and professional assistance to clients and providers, addressing inquiries, concerns, and complaints in a timely and effective manner.

Continuous Improvement: Identify opportunities for process improvement, efficiency gains, and enhanced customer satisfaction within the claims processing function.

Miscellaneous: Assist with projects, reporting, and other duties as requested by management.

Qualifications:

· High school diploma or equivalent.

· Experience with medical claims, preferably with Medicare and Medicaid claims processing.

· Program of All-inclusive Care for the Elderly (PACE) experience a plus.

· Strong understanding of healthcare claims processing and provider relations.

· Excellent verbal and written communication skills.

· Ability to work in a fast-paced environment and handle multiple tasks simultaneously.

· Knowledge of medical terminology and coding systems such as ICD-10, COT, and HCPCS.

· Excellent analytical skills with the ability to assess complex information and make sound decisions.

· Exceptional attention to detail and accuracy in data entry and record-keeping.

· Proficient computer skills, including experience with claim processing software and Microsoft Office applications.

· Effective communication skills, both written and verbal, with the ability to interact professionally with diverse stakeholders.

· Ability to prioritize tasks, manage workload efficiently, and meet deadlines in a fast-paced environment.

Pay: $21.00 - $22.00 per hour

Benefits:

• 401(k)
• Health insurance
• Paid time off
• Work from home

Application Question(s):

• You must have medical claims experience to be considered. Do you have at least 1 to 2 years of experience in medical claims, preferably medicare and medicaid .

Experience:

• medical claims: 2 years (Preferred)

Work Location: Remote