Claims Analyst III

ModivCare Solutions, LLC; United States; Remote; USD 61,000 - 80,000; Full time

Benefits offered by this job

Medical, Dental, and Vision insurance

Employer Paid Basic Life Insurance and

AD&D Voluntary Life Insurance (EMP/SPO

Health Care and Dependent Care FSAs

Commuter and Parking Benefits

401(k) Retirement Savings Plan with 1:

Paid Time Off

Paid Parental Leave

Short-Term and Long-Term Disability

Tuition Reimbursement

Employee Discounts

Job summary

Modivcare is seeking a seasoned claims processor to implement and audit claims processes, maximize accuracy, and support system enhancements. You will review claims for irregularities, request information when needed, and coordinate documentation and payments while mentoring junior staff.

The role requires a Bachelor's degree and 5+ years of experience in claims processing, with strong Excel/Outlook skills and excellent communication. Equal opportunity employer.

Qualifications

• Bachelor's Degree required.
• 5+ years of experience or equivalent combination.
• Strong understanding of claims processing and eligibility.
• Excellent attention to detail and data entry skills.
• Intermediate proficiency of Microsoft applications (Word, Excel, and Outlook).
• Analytical mindset to interpret claim data and guidelines.
• Excellent verbal and written communication skills.
• Ability to work independently and in a team.
• Type 35 words per minute and 10-key proficiency.

Responsibilities

• Reviews claims for irregularities, accuracy and completeness.
• Requests additional information for completion of claim processing.
• Coordinates and processes documentation, invoice disputes and payment.
• Performs account analysis and researches payment discrepancies.
• Identifies and verifies transactions and expedites resolution of claims issues.
• Handles complex issues and refers only the most complex to higher-level staff.
• Possesses comprehensive knowledge of subject matter.
• Provides leadership, coaching, or mentoring to junior team members.
• Participate in other projects or duties as assigned.

Skills

Bachelor's Degree

5+ years experience

Attention to detail

Data entry skills

Analytical mindset

Verbal and written communication

Team player

Typing 35 wpm & 10-key

Education

Bachelor's Degree

Tools

Microsoft Office

Job description

Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! This positions is responsible for implementing claims processes to maximize effectiveness and accuracy. This includes auditing the accuracy of claims information entered in the system and monitoring the operation of the claims systems. In addition develops solutions to claims issues and works with systems design to implement new features. You will...

Key responsibilities include:

• Reviews claims for irregularities, accuracy and completeness.
• Requests additional information, where necessary, for completion of claim processing.
• Coordinates and processes documentation, invoice dispute resolution and payment for accounts.
• Performs account analysis and researches payment and account discrepancies.
• Identifies and verifies transactions and expedites a resolution of various claims issues.
• Handles complex issues and problems, and refers only the most complex issues to higher-level staff.
• Possesses comprehensive knowledge of subject matter.
• Provides leadership, coaching, and/or mentoring to more junior team members.
• Participate in other projects or duties as assigned.

Required qualifications and experience:

• Bachelor's Degree required.
• Five (5) plus years of experience. Or equivalent combination of education and/or experience.
• Strong understanding of claims processing and ability to make informed decisions on claim eligibility.
• Excellent attention to detail and proficient data entry skills for accurate claim processing.
• Intermediate proficiency of Microsoft applications (Word, Excel, and Outlook).
• Analytical mindset with the ability to interpret claim data and follow established guidelines.
• Excellent verbal and written communication skills to interact with superior customer-focused demeanor.
• Problem-solving abilities to address claim issues and resolve discrepancies.
• Ability to work independently and as a member of a team.
• Ability to accurately type 35 words per minute and use of 10-key.

Salary: $60,800-$80,000

The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of the position. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the job. Primarily seated work; extensive computer and telephone use; occasional standing, walking, reaching, bending, and lifting up to 10 lbs.

Modivcare offers a comprehensive benefits package to include the following:

• Medical, Dental, and Vision insurance
• Employer Paid Basic Life Insurance and AD&D Voluntary Life Insurance (Employee/Spouse/Child)
• Health Care and Dependent Care Flexible Spending Accounts Pre-Tax and Post --Tax
• Commuter and Parking Benefits
• 401(k) Retirement Savings Plan with Company Match
• Paid Time Off
• Paid Parental Leave
• Short-Term and Long-Term Disability
• Tuition Reimbursement
• Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)

Modivcare is an Equal Opportunity Employer. EEO is The Law - click here for more information Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled We consider all applicants for employment without regard to race, color, religion, sex, sexual orientation, national origin, age, handicap or disability, or status as a Vietnam-era or special disabled veteran in accordance with federal law.

If you need assistance, please reach out to us at [e-mail] Due to system issues, if you are unable to search for your application, please reach out to the Talent Acquisition team via email at [e-mail] and a member of the Talent Acquisition team will reach out to you within the next 48 business hours.

Modivcare is leading the transformation to better connect people with care, wherever they are. We serve the most underserved by facilitating non-emergency medical transportation and personal and home care to enable greater access to care, reduce costs and improve outcomes.