Claims Processor III - Remote

Sentara Health Plans; Norfolk, Northern (VA, KY); Hybrid; USD 36,000 - 56,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision plans

Paid time off

Parental leave

Disability insurance

Life insurance

401k matching

Tuition assistance

Student debt pay down

Pet insurance

Legal resources

Annual bonus potential

Job summary

Sentara Health Plans in Norfolk, VA is seeking a full-time customer service and claims processor to support member acquisition and retention, and to manage claims processing. You will interact with members, providers and employers to ensure accurate administration of group information.

The role offers remote opportunities across multiple states and a comprehensive benefits package, emphasizing accuracy, service, and collaboration within a not-for-profit health system.

Qualifications

• HS or equivalent education required.
• CPC certification or related medical certification or 5 years claims processing experience or an associate degree or higher.
• Minimum 18 months claims processing experience; 2 years administrative experience; 2 years customer service; 2 years health plan claims disbursements.

Responsibilities

• Handle all areas of customer service as it pertains to the acquisition and/or retention of members.
• Process and administer group information, including processing of claims, interactions with members, providers and employers.

Skills

Customer service

Claims processing

Administrative tasks

Education

HS - High School Grad or Equivalent

CPC Certification OR Related Medical Certification OR 5 years direct claims processing experience OR Associates degree (or higher)

Job description

City/State: Norfolk, VA

Work Shift: Multiple shifts available. Status: Full-time, permanent position (40 hours). Work hours: 8am to 5pm EST, Monday to Friday. Location: Remote opportunities available in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming.

Job Responsibilities

• Responsible for all areas of customer service as it pertains to the acquisition and/or retention of members for Sentara Health Plan, Inc. This includes functions associated with the administration of all group information: processing of claims, interaction with member, providers and employers.

Education

• HS - High School Grad or Equivalent

Required Certifications/Licenses

• CPC Certification OR Related Medical Certification OR 5 years direct claims processing experience OR Associates degree (or higher)

Required Experience

• Minimum of 18 months claims processing experience. Must meet or exceed current claims processing standards to include: financial, check and processing accuracies.
• 2 years of Administrative experience
• 2 years Customer Service
• 2 years Health Plan Claims Disbursmnts

Benefits

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees. Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health. Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth. Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

Sentara Health is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!