Claims Inspection Representative

JOB DESCRIPTION:

POSITION SUMMARY

The Claims Inspection Representative is responsible for handling claims review through an established checklist to ensure accurate claim requirements are met before it is released to the insurance.

JOB RESPONSIBILITIES:

• Conduct thorough reviews of submitted claims by applying a standardized checklist of requirements to ensure accuracy completeness and compliance with internal policies and payer guidelines.

• Accurately identify discrepancies errors or non-compliance issuesreferred to as Failpointsduring the claims review process. These findings must be clearly documented and promptly communicated to the appropriate internal departments to initiate necessary corrective actions and ensure process integrity.

• Maintains accurate patient information in relevant Acelis Connected Health data management systems.

• Applies knowledge of company processes and procedures to respond to incoming communication from insurance companies patients and internal departments.

• Performs other related duties as assigned.

MINIMUM REQUIREMENTS:

• College diploma or equivalent but more education especially in management or healthcare is preferred.

• Minimum of 2 years of experience in healthcare accounts (preferably Revenue Cycle Management work experience).

• One to two years data processing experience preferred

• One to two years customer service or provider relations experience preferred

• Proficiency with technology especially computers software applications and phone systems.

• Good verbal and written communication skills.

• Strong understanding of company products policies and services.

COMPETENCIES

• Fostering Teamwork

• Commitment to Job Deliverables

• Decision making

• Attention to Details

• Attention to Communication

• Customer Orientation

• Analytical Thinking

• Leadership

• Trustworthiness and Ethics

• Problem Solving

• Technical Expertise

• Managing Change

• Managing Performance

• Adaptability

• Initiative

• Interpersonal Skills

• Thoroughness

• Self Confidence

• Stress Management

• Personal Credibility

• Flexibility

COMMUNICATION SKILLS

• Excellent interpersonal skills

• Detailed & Team Oriented

• Professional communication & Writing Organization/Time Management Skills

TECHNICAL SKILLS

• Detail-oriented

• Basic Excel Word and Outlook experience required.

• Demonstrates proficiency and accuracy using Alere Home Monitoring data management systems which are directly related to the specific job function.

• Strong Computer/Software Skills

PHYSICAL ABILITIES

• Must be able sit at a standard workstation for long periods

• Must be able to work with a standard computer and monitor using keyboard

• No lifting required for this position

• Must have the ability to get to work on time and work for the entire assigned shift

• Must be able to work a night shift from minimum 8:00 pm to 8:00 am Philippine Standard Time.

The base pay for this position is

In specific locations the pay range may vary from the range posted.

JOB FAMILY:

DIVISION:

LOCATION:

ADDITIONAL LOCATIONS:

WORK SHIFT:

TRAVEL:

MEDICAL SURVEILLANCE:

SIGNIFICANT WORK ACTIVITIES: