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Job Description

Overview: Our client is seeking two contract-to-hire professionals to join their team as Claims Investigators / Process Specialists. These roles are pivotal in ensuring the accuracy and efficiency of claims processing.

Key Responsibilities:

-Develop Solutions: Create and implement processes to address overpaid claims challenged by providers.

-Investigate Claims: Thoroughly review and document claims that have been disputed.

-Collaborate: Work closely with the claims team to analyze data and temporarily halt reprocessing during investigations.

-Track Progress: Maintain detailed records of investigations using Excel.

-Strategize: Move forward with retractions and develop strategies to prevent future errors.

-Communicate: Present ideas and updates to leadership and team members to enhance processes.

-Pay rate between $20-38/hr depending on experience

We are a company committed to creating inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity employer that believes everyone matters. Qualified candidates will receive consideration for employment opportunities without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, disability, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [email protected] . The EEOC "Know Your Rights" Poster is available here (https://www.eeoc.gov/sites/default/files/2023-06/22-088\_EEOC\_KnowYourRights6.12ScreenRdr.pdf) .

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Skills and Requirements

-Experience: Proven background in claims investigation within a health plan or healthcare setting.

-Negotiation Skills: Experience in negotiating payment agreements with providers.

Technical Proficiency: Proficient in Microsoft Word and Excel.

-Organizational Skills: Strong ability to organize and document information effectively.

-Team Collaboration: Excellent communication and collaboration skills with teams and leadership. - Qnxt Experience: Familiarity with Qnxt software is a plus. null

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to [email protected].