Claims Intake Specialist II - Part Time - Fully Remote!

SKYGEN; Menomonee Falls (WI); Remote; USD 42,000 - 52,000; Full time

Job summary

SKYGEN is seeking a remote claims processing associate in Wisconsin. The role involves ensuring timely completion of claim payments and authorizations, supporting data-entry processors, and handling special workflows per client rules.

The position requires at least 1 year in claim processing or related health insurance roles, with strong data-entry speed and attention to detail. A pre-employment assessment is required, and the work schedule is Mon-Fri, 12:00pm-5:00pm CST.

Qualifications

• Passing a pre-employment online alphanumeric data entry assessment with a minimum 7000 KSPH and 98% accuracy.
• Ability to work effectively with multiple interruptions.
• Strong organizational skills to meet deadlines.
• Excellent attention to detail.
• Ability to multitask.
• Resourceful problem solving with minimal supervision.
• Strong critical thinking.
• Excellent verbal and written communication.
• Basic Microsoft Office applications.
• Knowledge of insurance EOBs and billing codes.
• Knowledge of ADA UB-04 forms and related submission rules.

Responsibilities

• Coordinate daily work plans and assign tasks to the team to meet client turnaround times.
• Provide second-tier guidance to data entry processors for submission discrepancies.
• Manage specialized workflows deviating from standard processes and coordinate resolution.
• Review reports, ensure queues and issues are resolved before claim payment/authorization.
• Flag potential issues to management for timely resolution.
• Multitask across Enterprise System modules to retrieve information and process requests.
• Understand client processing guidelines and requirements.
• Process insurance EOBs for payment.
• Act as SME for items sent to Claims Intake and resolve matters.
• Alert provider submission errors and coordinate provider outreach.
• Handle urgent OR authorization requests via fax with the authorization team.
• Resolve provider data discrepancies and validate credentials.
• Assist with training of internal team members.
• Partner with Claims Intake to meet SLAs.
• Assist with special projects requested by leadership.

Skills

Data entry

Attention to detail

Multitasking

Critical thinking

Verbal & written communication

Microsoft Office basics

Insurance knowledge

EOBs & billing codes

ADA forms knowledge

Education

High school diploma or equivalent

Bachelor's Degree in a related field

Job description

Important things YOU should know:

• Fully Remote Opportunity
• Schedule: Monday - Friday - 12:00pm - 5:00pm CST

• Successfully complete a pre-employment online alphanumeric data entry assessment with a minimum score of 7000 KSPH and 98% accuracy rate.

What will YOU be doing for us?

Responsible for ensuring departmental tasks are completed in order to meet client turnaround times for claim payment and authorization determination. Manages all special handling requests to support both internal and external requirements

What will YOU be working on?

• Manages daily work plan and distributes work out to the team to ensure client turnaround times are met.
• Provide second tier support to data entry processors by providing direction how to resolve submission discrepancies according to client business rules.
• Manage specialized workflows to support client requests that deviate from standard processes and procedures. Coordinate resolution with required departments as necessary.
• Responsible for ensuring all reporting is reviewed, work queues are completed, and open issues are resolved prior to claim payment and authorization review. Proactively communicate readiness to transfer data to appropriate departments.
• Proactively communicate potential issues to management to allow for timely resolution.
• Ability to multitask within multiple modules of the Enterprise System to retrieve and research information along with processing any submission requests or special handling requests received.
• Comprehensive understanding of client processing guidelines and requirements.
• Process primary insurance carries EOB's for appropriate payment.
• Act as a subject matter expert for items sent to the Claims Intake team; answering questions to internal and external contacts and resolving matters that may fall outside of the established workflows.
• Proactively bring forward provider submission errors and collaborate with internal teams for provider outreach and education.
• Manage and process urgent operating room (OR) authorization requests submitted via fax and coordinate with the authorization team to ensure timely review and determination outcome.
• Resolve provider data discrepancies submitted electronically that prevent the submission to proceed through the system. Utilize outside databases to validate provider credentials.
• Assists with training support of internal team members.

Additional Responsibilities:

• Partner with Claims Intake team in completing all other tasks as necessary to ensure accurate and timely completion of work to meet our client service level agreements.
• Assist with special projects requests assigned by leadership team.

What qualifications do YOU need to have to be a GOOD candidate?

Required Level of Education, Licenses, and/or Certificates

• High school diploma or equivalent.

Required Level of Experience

• 1+ year(s) of related experience such as claim processing, dental assistant, dental front office administration and/or health/dental insurance such as managed care operations, accounts receivable and/or billing environment.

Required Knowledge, Skills, and Abilities

• Successfully complete a pre-employment online alphanumeric data entry assessment with a minimum score of 7000 KSPH and 98% accuracy rate.
• Ability to work effectively with multiple interruptions.
• Ability to organize work appropriately to meet deadlines.
• Excellent attention to detail.
• Ability to multi-task.
• Ability to utilize resources to solve problems independently.
• Excellent Critical thinking skills.
• Excellent verbal and written communication skills.
• Basic Microsoft applications.
• Knowledge of insurance EOB's and billing codes.
• Knowledge of American Dental Association (ADA) forms, UB-04 Facility Claim form or Member Reimbursement forms.

What qualifications do YOU need to have to be a GREAT candidate?

Preferred Level of Education, License, and/or Certificates

• Bachelor's Degree in a related field.

Preferred Level of Experience

• 2+ years of medical, dental or vision claim processing.