Claim Resolution Specialist

Primary Responsibilities:

• Coordinate between departments to resolve member billing issues, including, but not
  limited to contacting providers and/or facilities to update insurance information and
  resolve billing discrepancies.
• Research claims issues resulting in member balance billing
• Responds to member billing inquiries through written correspondences and/or phone
  calls.
• Handles sensitive member interactions.
• Maintains timely, accurate documentation in the claims system for all appropriate
  transactions.
• Reports problems, errors, and denial trends to management including PHI breaches.
• Meets the performance goals established for the position in the areas of: efficiency,
  accuracy, quality, member and provider satisfaction.

Required Qualifications:

• High School Diploma / GED OR equivalent years of working experience
• Must be 18 years of age OR older
• 1 year of healthcare billing and/or health plan experience.
• A basic understanding PPO benefits

Preferred Qualifications:

• Healthcare / Insurance billing industry experience
• Medical terminology acumen and experience
• Billing experience and understands multiple billing requirements across various payers
  and states. Knowledge of billing in the state of Texas is a plus.
• Experience working in the Google workspace (Gmail, sheets, docs).

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living
  areas and provides information privacy.
• Must live in a location that can receive an approved high-speed internet connection or
  leverage an existing high-speed internet service.

Soft Skills:

• Ability to multi – task and to understand multiple products and multiple levels of benefits
  within each product
• Previous work experience in a fast – paced environment requiring multi – tasking skills
• Ability to resolve calls, avoiding escalated complaints
• Ability to exhibit empathy and be courteous to callers
• Ability to triage and handle escalated situations
• Ability to work in a fast – paced environment
• Ability to adapt to changes
• Ability to work independently and as part of a team