[Remote] Senior Claim Benefit Specialist - Remote

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is the nation’s leading health solutions company, dedicated to transforming health care. They are seeking a Senior Claim Benefit Specialist who will review and adjudicate reputed company claims, reputed company training and support to junior staff, and ensure compliance with processing guidelines. Responsibilities • Reviews reputed company-specified claims or claims that reputed company specialist adjudication authority or processing expertise • Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies reputed company cost containment measures to assist in the claim adjudication process • Handles phone and written inquiries reputed company to requests for reputed company-approval/reputed company-authorization, reconsiderations, or appeals • Insures reputed company compliance requirements are satisfied and reputed company payments are made against company practices and procedures • Identifies and reports possible claim overpayments, underpayments and any other irregularities • Performs claim rework calculations • Distributes work assignment daily to junior staff • Trains and mentors claim benefit specialists • Makes outbound calls to obtain required information for claim or reconsideration Skills • 18+ months of medical claim processing experience • Experience in a production environment • Demonstrated ability to handle multiple assignments competently, accurately and reputed company • High School Diploma required • Self-Funding experience • DG system knowledge • Preferred Associates degree or equivalent work experience Benefits • reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. • No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. reputed company • reputed company is a health solutions company that provides an integrated reputed company services to its members. It was founded in 1963, and is headquartered in Woonsocket, Rhode reputed company, USA, with a workforce of 10001+ employees. Its website is https://www.reputed company.com/. Apply tot his job Apply To this Job