Remote Medicare Advantage Claims Specialist

RAM Health; United States; Remote; USD 25,000 - 28,000; Full time

Benefits offered by this job

Remote work

Health insurance

Dental & Vision insurance

Vacation and holiday pay

401k with company match

Life insurance

AD&D

Long-term disability

HSA and FSA

Tuition reimbursement

Parental leave

Job summary

RAM Health is seeking a Claims / Encounter Specialist to review pended claims, apply business rules, and finalize decisions in line with regulatory and client expectations. You will also prepare claims data for encounters and assist with adjustments and appeals as needed.

The role requires 1–3 years in the healthcare payer space (Medicare Advantage, Managed Medicaid) with strong attention to detail, solid MS Word/Excel skills, and clear written and oral communication.

Qualifications

• 1–3 years in healthcare payer space (Medicare Advantage, Managed Medicaid)
• Experience in production environment
• Ability to apply documented procedures to achieve outcomes

Responsibilities

• Perform timely and accurate claim adjudication and adjustments
• Adjudicate specialty claims (ambulatory surgery, dental, DME, etc.)
• Prepare encounters for submission and correct rejected encounters
• Support system inquiries from member and provider call center services
• Research and review Claims Appeals information to support client inquiries
• Meet established production and quality standards
• Identify opportunities to improve efficiency within assigned processes

Skills

MS Word

MS Excel

Communication skills

Attention to detail

Education

High School Diploma

Tools

BPaaS experience

Job description

RAM Health is seeking a Claims / Encounter Specialist to review pended claims, apply business rules, and finalize decisions in line with regulatory and client expectations. You will also prepare claims data for encounters and assist with adjustments and appeals as needed.

The role requires 1–3 years in the healthcare payer space (Medicare Advantage, Managed Medicaid) with strong attention to detail, solid MS Word/Excel skills, and clear written and oral communication.