BPO HC |amp| Insurance Operations Senior Associate

Review Processes Healthcare payer claims including HCFA UB forms.
Validate Member, Provider and other Claims information.
Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure.
Coordination of Claim Benefits based on the Policy Procedure.
Maintain productivity goals, quality standards and aging timeframes.
Scrutinizing Medical Claim Documents and settlements.
Organizing and completing tasks per assigned priorities.
Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the tea
Resolving complex situations following pre-established guidelines

Requirements for this role include:

University degree or equivalent that required formal studies of the English language and basic Math
3+ Year of experience where you had to apply business rules to varying fact situations and make appropriate decisions
3+ Year... Read more