What are the responsibilities and job description for the Claim Resolution Specialist position at Curative?
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.
- 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
- 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).
- 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.
- 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
