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Doral, FL »
Claims Processor Associate (Temporary)
1 week ago
H/S diploma or equilivent
Apply / More Info
Kelly Services is now hiring for experienced Claims Specialists to work for a well establish national organization located in Doral, Florida.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Examine and processes claims for determinations (e.g. return, pend, deny or pay claims).
Determine steps necessary for adjudication.
Settle claims with claimants in accordance with policy provisions.
Compares claim application and/or provider statement with policy file and other records to evaluate completeness and validity of claim.
Interacts with agents and claimants by mail or phone to correct claim form errors or omissions and to investigate questionable entries.
B020 CHC- CORE MEDICAL BH01 HEALTHSPRING INTEGRATION EXP
Review and adjudication of clean claims, eligibility and appropriate authorization.
Reviews claim history for potential duplicates, denials, referrals, and COB.
Reviews claim for financial responsibility.
KNOWLEDGE, SKILLS AND ABILITIES:
Fluent in English and Spanish.
Skills: Data entry skills. Ability to handle multiple tasks. Ability to correctly complete assignments within specified time frames. Familiarity with medical and/or insurance terminology.
Education: High School Diploma or equivalent.
Excellent oral and written communication and human relations skills required.
Ability to work effectively in a team environment.
Knowledge of medical terminology.
1 Year experience in claims processing a must.
Procedure code and diagnosis coding experience preferred.
2-5 years of experience processing and adjudicating claims.
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