Medical Benefits Claims Advocate

Valeris; North Carolina; Sur place; USD 52 000 - 76 000; Plein temps

Avantages offerts par ce poste

Medical plan

Dental plan

Vision plan

HSA/FSA options

401(k) match

PTO & holidays

Career growth

Résumé du poste

Valeris is seeking a Medical Claims Specialist to work with provider offices on medical benefit copay programs, handling inquiries, troubleshoot claim statuses, and coordinate with outside vendors to resolve escalations.

You will support pharmaceutical reps with sites related to medical benefit programs, maintain confidentiality, and ensure end-to-end understanding of medical claim processes. This role requires meticulous attention to detail and strong communication.

Qualifications

• Associate or Bachelor’s degree preferred; or a minimum of 5 years of customer service/medical claim experience.
• Strong understanding of medical claims processing, rejection troubleshooting, reversals / adjustments, and provider medical claims workflows a plus.
• Ability to provide articulates verbal and written communication.
• Proficient with Microsoft products including MS Excel and data review.

Responsabilités

• Manages day-to-day activities and escalations of multiple medical benefit copay programs as assigned
• Assists stakeholders by acting as an advocate delivering detailed information for various medical claim situations
• Serves as focal point for provider medical claim escalations
• Conducts outreach to provider sites, patients and other stakeholders associated with supported programs
• Maintains records in accordance with applicable standards and regulations to the programs/promotions

Connaissances

Claims processing

Troubleshooting

Provider workflows

Verbal & written comms

MS Excel

Vendor management

Formation

Bachelor’s degree preferred

Associate degree preferred

5+ years customer service/medical claims

Outils

MS Excel

Description du poste

Valeris is seeking a Medical Claims Specialist to work with provider offices on medical benefit copay programs, handling inquiries, troubleshoot claim statuses, and coordinate with outside vendors to resolve escalations.

You will support pharmaceutical reps with sites related to medical benefit programs, maintain confidentiality, and ensure end-to-end understanding of medical claim processes. This role requires meticulous attention to detail and strong communication.