Remote Claims Adjudicator - Health Insurance

Wellcove; United States; À distance; USD 40 000 - 65 000; Plein temps

Résumé du poste

Wellcove is seeking a Claims Adjudicator to manage outbound calls and adjudicate US health claims. You will review medical reports, calculate claim amounts, and determine action per guidelines to resolve denied or underpaid claims.

You will work remotely, requiring strong English comprehension, medical terminology knowledge, and the ability to research, summarize, and recommend courses of action with minimal supervision.

Qualifications

• Experience in handling US HIP claims.
• Knowledge of ICD 10, CPT, Surgery procedures, Revenue codes, medical terminology, medical documents, Inpatient vs Outpatient claims.
• Experience reading and comprehending medical documents.

Responsabilités

• Adjudicating HP/AD claims.
• Handling all Outbound calls.
• Prioritize work and adjudicate claims per turnaround time.
• Research, review, summarize and recommend actions on claims where an appeal or grievance has been filed for a denied/under payment.
• Explain and ensure accuracy in claim calculations for customers.
• Respond to and resolve claims received via emails.
• Comply with HIPAA, confidentiality, and privacy regulations.

Connaissances

Medical terminology

Math basics

Problem solving

Detail oriented

Adaptability / quick learner

Work under pressure

English comprehension

Formation

High school diploma or GED

Description du poste

Wellcove is seeking a Claims Adjudicator to manage outbound calls and adjudicate US health claims. You will review medical reports, calculate claim amounts, and determine action per guidelines to resolve denied or underpaid claims.

You will work remotely, requiring strong English comprehension, medical terminology knowledge, and the ability to research, summarize, and recommend courses of action with minimal supervision.