Claims Processor
Claims Processor
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
About the Role:
We are seeking a Claims & Appeals Specialist with strong experience in facilitylevel claims preferably from the payer side. This individual will manage appeals resolve claims issues (including PENS) and communicate with providers and internal stakeholders. The role involves roughly 2 hours of daily phone work with the remainder of the day focused on appeals and claims resolution. This is a hybrid role with the potential to become fully remote.
Qualifications :
Required Skills:
Facility claims and appeals processing experience
Strong knowledge of Medicare and Medicaid claims
Excellent phone communication skills and comfort working with providers
Ability to work independently and make appeal decisions
Experience collaborating with auditors nurses and physicians
Proficiency with Microsoft Teams
Preferred Skills:
Experience with PCM claims software (highly preferred)
Familiarity with BRG coding and hospital claim workflows
Background working with claims that fall out of systems (PENS)
Previous call center experience (for contracttohire track)
Additional Information :
About the Company:
Our client is a leading healthcare payer organization committed to improving claims accuracy and supporting providers through transparent timely resolutions. They offer a supportive environment with flexibility professional development and opportunities to work crossfunctionally with clinical and compliance teams.
Hourly: $20$25
Talent Navigation Experts is an Equal Opportunity/Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity employer.
Remote Work :
Yes
Employment Type :
Fulltime
Employment Type
Remote
