Remote Medical Claims Processor I (Temporary role)

About the Role

This role is Temp thru November with a chance for follow-on work. Become an integral part of a dedicated team supporting the World Trade Center Health Program. In this role, you will leverage your strong attention to detail and commitment to accuracy in processing complex medical claims.

Work Schedule

• Remote
• Monday through Friday, 8:30 AM to 5:00 PM EST
• Must be able to work 8am - 5pm Eastern Standard Time

Responsibilities

Claims Review and Processing

• Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance.

Critical Analysis

• Adjudicate claims according to program guidelines, applying critical thinking skills to navigate complex scenarios.

Timely Processing

• Ensure prompt claims processing to meet client standards and regulatory requirements.
• Identify and resolve any barriers using effective problem-solving strategies.

Issue Resolution

• Collaborate with internal departments to proactively resolve discrepancies and issues.
• Use analytical skills to identify root causes and implement solutions.

Confidentiality Maintenance

• Uphold confidentiality of patient records and company information in accordance with HIPAA regulations.

Detailed Record Keeping

• Maintain thorough and accurate records of claims processed, denied, or requiring further investigation.