Medical Claims Specialist — Copay Programs

Valeris; United States; Remote; USD 25,000 - 39,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

Telehealth and EAP services

401(k) Retirement Savings Plan with 5%

Job summary

Valeris is hiring a Medical Claims Specialist to work directly with provider offices on medical benefit copay programs. You will troubleshoot claim submissions, investigate claim status, and coordinate with vendors to resolve issues while maintaining confidentiality and quality service.

You will support multiple programs, engage with providers and patients, and help optimize processes with a focus on accuracy and timely communications.

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 exceptionally articulate verbal and written communication
• Proficient with Microsoft products including MS Excel skills with the ability to review data sets to conclude outcome
• Directly supporting and liaising between the client facing teams and technology & operational delivery teams
• Ability to manage and prioritize workload based on competing demands
• Customer Service – ability to collaborate with users to articulate requests, issues and resolution on time
• Experience managing vendors, contractors, sub-contractors
• Proven problem-solving abilities and strong organizational skills to successfully manage various types of escalations
• Logical and efficient with attention to detail and committed follow through in communication with all stakeholders
• Willing to work in a dynamic, fast paced environment and have the ability to multi-task with multiple escalations
• Strong interpersonal skills, ability to work both independently and as part of a team

Responsibilities

• Manages the day-to-day activities and escalations of multiple medical benefit copay programs as assigned
• Assists all stakeholders by acting as an advocate delivering detailed information for various medical claim situations
• Serves as focal point for provider medical claim escalations
• Conduct outreach to provider sites, patients and other stakeholders associated with supported programs
• Provides unparalleled customer service while serving as a service representative
• Analyzes and decides actions for each situation with discretion
• Supports pharmaceutical reps with their sites related to medical benefit programs
• Understands end-to-end medical claim processes to investigate scenarios and resolve issues
• Maintains confidentiality and privacy in all activities
• Maintains records per standards and regulations for programs/promotions
• Evaluates programs to recommend new tools, forms, and procedures
• Participates in team meetings and improvement initiatives
• Collaborates with external vendors and internal stakeholders to document escalations and resolutions
• Participates in continuing education to stay knowledgeable about programs/promotions

Skills

Medical claims processing

Troubleshooting claims

Provider workflows

Verbal communication

Written communication

MS Excel

Vendor management

Customer service

Multitasking

Attention to detail

Team collaboration

Education

Associate or Bachelor’s degree preferred

Tools

MS Office

Job description

Valeris is hiring a Medical Claims Specialist to work directly with provider offices on medical benefit copay programs. You will troubleshoot claim submissions, investigate claim status, and coordinate with vendors to resolve issues while maintaining confidentiality and quality service.

You will support multiple programs, engage with providers and patients, and help optimize processes with a focus on accuracy and timely communications.