Medical Claims Examiner (Remote)

Are you looking for a career with an established company who values its employees? Administrative Concepts, Inc. (ACI) is a fast-growing company that offers its employees meaningful work and a positive environment. Founded in 1997, ACI is a nationally licensed, full-service, Third-Party Administrator providing enrollment, fulfillment and claims processing services for various insurance lines in the medical claims industry.

GENERAL PURPOSE OF THE JOB: Review and process claims in accordance with training, guidelines, carrier directives, and policy provisions.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Responsible for reviewing and maintaining a working knowledge of policy and state mandated insurance requirements.
• Responsible to review and process claims for assigned accounts and back up as needed.
• Prepare large claim files for review and send notifications in accordance with best practices for large claims.
• Meet daily/weekly production goals established by management while maintaining processing and financial accuracy standards (95% minimum accuracy required).
• Request refunds, voids, and no-pay adjustments as needed.
• Respond to phone and email inquiries from clients, customers, and business partners (agents, brokers) when needed.
• Provide customer service assistance in responding to benefit and claim questions.
• Respond to questions and specific requests and provide complete information and documentation as needed.
• Responsible to complete special projects.
• Request subrogation and reimbursement letters from appropriate source.
• Review and monitor the suspended claims list to ensure claims are processed within appropriate time limits.
• Complete training rolled out by HR and claim management throughout the year.
• Attend all individual, department and organizational meetings.
• Uphold all company policies, procedures, and HIPAA guidelines
• Adhere to the schedule they have selected, begin work on time.
• Responsible to perform in accordance with all policies and provisions outlined in the ACI handbook.
• Examiners must obtain and maintain individual adjuster licenses within the first twelve months of employment.
• Other claim department duties as assigned by the manager.

DESIRABLE QUALIFICATIONS:

• Knowledge of industry and medical terminology and codes
• Understanding of the adjudication process
• Ability to prioritize and organize
• Strong verbal and written communication skills
• Strong data entry skills
• Experience with MS Office

Pay: $21.00 - $24.00 per hour

Benefits:

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

Work Location: Remote