Job Description and Tasks
Ideal candidates will be able to settle a high volume of claims using creative, innovative, and flexible argumentation. We will provide intensive training in writing, legal argumentation, and medical record analysis. From there, thinking outside the box is a must.
Candidate will manage an ample case load of corporate health claims. This involves filing written appeals through administrative appeals processes to resolve problematic (e.g., underpaid or denied) medical claims for payment with health, governmental, and corporate health payers.
Candidate will be required to perform the following duties:
- Quickly and efficiently review medical records and submit well-written appeals to health insurers and governmental payers.
- Be comfortable, skilled, assertive, cordial, and professional on the telephone to follow up on submitted appeals.
- Navigate through various computer systems and applications to find information about insurance claims.
- Navigate through unfamiliar jurisdictions and processes in order to appeal and settle claims.
- Undergraduate and graduate degree with GPA of 3.0 or higher.
- Proficiency in Microsoft Office including Word and Excel with the ability to quickly learn and operate new computer programs and software.
- Highly attentive to detail and able to handle large amounts of paperwork for a busy office.
- Excellent organizational and time management skills.
- Clear, concise, and logical writing style.
- Must be highly organized, aggressive, innovative, outgoing, goal-oriented, and a leader who can advise both clients and support staff including legal assistants and paralegals.
- Basic working knowledge of medical terminology and diagnostic procedures.
- Previous coursework and/or work experience in biological sciences or healthcare.
- Prior experience in a clinical healthcare setting strongly preferred.