Claims Specialist I
Claims Specialist I
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Job Description
Are you passionate about making a difference in peoples lives Do you enjoy working in a serviceoriented industry If so this opportunity may be the right fit for you!
This position is responsible for processing and managing claims submitted by providers includes checking for accuracy and completion of documentation and attachments.
In this role you will...
- Reviews incoming claims and related documentation to ensure accuracy and completeness.
- Enters claim information and relevant details into the claims processing system.
- Reviews company policies to determine coverage and assess validity of claim.
- Obtains missing information by using standard scripts or form letters.
- Applies established guidelines and policies to determine claim eligibility and process claims accordingly.
- Communicate with providers when applicable to gather additional information or clarify claim details.
- Adhere to departmental deadlines policies and procedures in handling of claims.
- Reports suspected fraudulent claims to Fraud Waste and Abuse (FWA) department.
- Participate in other projects or duties as assigned.
We are looking for someone with...
- High School Diploma required.
- Zero 0 plus years of experience.
- Or equivalent combination of education and/or experience.
- Strong attention to detail and data entry skills for accurate claim processing.
- Basic computer proficiency including knowledge of Microsoft applications (Word Excel and Outlook).
- Analytical mindset with the ability to interpret claim data and follow established guidelines.
- Effective verbal and written communication skills to interact with superior customerfocused demeanor.
- Problemsolving abilities to address claim issues and resolve discrepancies.
- Ability to work independently and as a member of a team.
Pay Range: $12.37 $16.70/hourly
Modivcares positions are posted and open for applications for a minimum of 5 days. Positions may be posted for a maximum of 45 days dependent on the type of role the number of roles and the number of applications received. We encourage our prospective candidatesto submit their application(s) expediently so as not to miss out on our opportunities. We frequently post new opportunities andencourage prospective candidates to check back often for new postings.
We value our team members and realize the importance of benefits for you and your family.
Modivcare offers a comprehensive benefits package to include the following:
- Medical Dental and Vision insurance
- Employer Paid Basic Life Insurance and AD&D
- Voluntary Life Insurance (Employee/Spouse/Child)
- Health Care and Dependent Care Flexible Spending Accounts
- PreTax and Post Tax Commuter and Parking Benefits
- 401(k) Retirement Savings Plan with Company Match
- Paid Time Off
- Paid Parental Leave
- ShortTerm and LongTerm Disability
- Tuition Reimbursement
- Employee Discounts (retail hotel food restaurants car rental and much more!
Modivcare is an Equal Opportunity Employer.
- EEO is The Law click here for more information
- Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
- We consider all applicants for employment without regard to race color religion sex sexual orientation national origin age handicap or disability or status as a Vietnamera or special disabled veteran in accordance with federal law. If you need assistance please reach out to us at
Required Experience:
Unclear Seniority
Employment Type
Full-Time
