Claims Specialist

Direct Staffing Inc; Town of Florida (NY); On-site; USD 20,664 - 22,041; Full time

Benefits offered by this job

Competitive pay

Paid holidays

Year-end bonus program

Access to continuing education

Insurance options available immediately upon hire

Job summary

A staffing agency is looking for a Claims Specialist to handle claims processing for their client in Lake Mary, FL. The ideal candidate should have a High School Diploma or GED and 1-3 years of Call Center and Reimbursement experience. Responsibilities include verifying claims, communicating with various departments, and adhering to HIPAA regulations. Offers competitive pay and various employee perks such as access to a learning center and insurance options.

Qualifications

• High School Diploma or GED required.
• 1–3 years of experience in a Call Center and Reimbursement setting.
• Proficient in data entry and 10-key skills.

Responsibilities

• Verify submitted claims for completeness and accuracy.
• Process claims according to specific client guidelines.
• Communicate with internal departments and outside agencies regarding claims.

Skills

Data entry proficiency

Knowledge of drugs and drug terminology

Strong communication skills

Analytical skills for fraud detection

Education

High School Diploma or GED

1–3 years of Call Center and Reimbursement experience

Tools

MS Word

Excel

Job description

At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100™ companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.

Job Description

Kelly Services is currently seeking several Claims Specialist for our client's Lake Mary, FL location.

In addition to working with the world’s most recognized and trusted name in staffing, Kelly employees can expect:

• Competitive pay
• Paid holidays
• Year‑end bonus program
• Recognition and incentive programs
• Access to continuing education via the Kelly Learning Center

Pay $15 - $16 per hour

Schedule: Monday through Friday – 9:00 am to 6:00 pm

Duration: 4 months, possible extension (possible temp‑to‑perm)

Anticipated start date: 10/31/2016 to 03/31/2017

SUMMARY Responsibility for various reimbursement functions, including but not limited to accurate and timely claim submission, claim status, collection activity, appeals, payment posting, and/or refunds until accounts receivable issues are properly resolved.

MAJOR JOB DUTIES AND RESPONSIBILITIES

• Verify member submitted claim forms, member’s eligibility and pharmacy information is complete and accurate, updating system information as needed.
• Provide superior data entry proficiency to ensure accurate and timely processing of claims submitted by member, pharmacy or appropriate agency.
• Maintain moderate knowledge of drugs and drug terminology used daily.
• Process claims according to client specific guidelines while identifying claims requiring exception handling.
• Navigate daily through several platforms to research and accurately finalize claim submissions.
• Communicate orally or in writing with internal departments, members, pharmacies or agencies to resolve claim issues.
• Adhere to strict HIPAA regulations, especially when communicating to others outside.
• Prioritize and coordinate influx of daily workload for claims processing, returned mail and outgoing correspondence and e‑mails to meet required turnaround time.
• Assess accuracy of system adjudication and alert management of potential problems affecting the integrity of claim processing.
• Analyze claims for potential fraud by member or pharmacy.
• May be required to work on special projects for the claims team.

EDUCATION/EXPERIENCE

• High School Diploma or GED required.
• 1–3 years of Call Center and Reimbursement experience required.
• Knowledge of completed benefits verifications, submitted test claims, and completed or reviewed prior authorizations required.
• Strong data entry and 10‑key skills.
• Proficient in MS Word and Excel.

Additional Information

Why Kelly?

As a Kelly Services candidate you will have access to numerous perks, including:

• Exposure to a variety of career opportunities as a result of our expansive network of client companies.
• Career guides, information and tools to help you successfully position yourself throughout every stage of your career.
• Access to more than 3,000 online training courses through our Kelly Learning Center.
• Group‑rate insurance options available immediately upon hire*