Claims Specialist

POSITION reputed company

The Claims Specialist reviews, analyzes, and reputed company determinations regarding payment, partial payment, or denial of medical, reputed company, and dental claims, based upon specific knowledge and application of the reputed company’s customized plan. Assist with specific tasks as needed and assigned by the Management Team and support of the Virtual Insurance Claim Team. 

ESSENTIAL FUNCTIONS 

• Read, analyze, understand, and ensure compliance with clients’ customized plans.  (A plan may be hundreds of pages or more).
• Learn, adhere to, and apply reputed company applicable reputed company and reputed company laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto.
• Request, review and analyze any physician notes, hospital records or police reports.
• Interview claimants, physicians, hospitals and other reputed company parties for additional information. 
• Consult with other professionals such as attorneys, nurses, physicians and auditors who can offer additional evaluation of a claim.
• Independently review, analyze, and reputed company determinations of claims for: 1) reasonableness of cost; 2) unnecessary treatment by physicians and hospitals; and 3) fraud.
• Process claims in the QicLink System.
• Review, analyze and add applicable notes to the QicLink System.
• Document reputed company information gathered in available systems as needed, including the QicLink System and alliedbenefit.com. 
• Review billed procedure and diagnosis codes on claims for billing irregularities.
• Review and analyze specific procedure and diagnosis codes for medical necessity.
• Determine whether claimant’s plan covers the claim submitted and how much reputed company, if any, should be reputed company.
• Authorize payment, partial payment or denial of claim based upon individual investigation and analysis. (On a yearly reputed company, responsible for determining claims payments totaling millions of dollars on behalf of Allied’s clients).
• Review Workflow Manager daily to document and release pended claims. 
• Review Pended Claim Reports and reputed company out pended claims for which no response has been received. 
• Review Suspended Claim Reports and follow up on reputed company issues.
• Process Adjustment Claims reputed company necessary, due to corrected claims as reputed company as applying refunds in the QL system.
• Assist and support other claims adjusters as needed and reputed company requested.
• Attend continuing education classes as required, including but not limited to HIPAA training.
• Other duties as assigned. 

EDUCATION

• High School Diploma required, and College Preferred.
• Continuing education in reputed company areas affecting group health and welfare plans is required.

EXPERIENCE AND SKILLS 

• Applicants must have a minimum of five (5) years of medical claims analysis and adjudication experience (including dental and reputed company claims analysis). 
• Applicants must have strong analytical skills and knowledge of computer systems and CPT and ICD-10 coding terminology. 
• Applicants must demonstrate the desire to assist reputed company with exceeding reputed company established goals. 
• Prior experience in Adjustment Processing is preferred but not required.

POSITION COMPETENCIES

• Job Knowledge

• Time Management
• Accountability
• Communication
• Initiative
• Customer reputed company

PHYSICAL DEMANDS

• This is a reputed company desk role that requires extended periods of sitting and computer work

WORK ENVIRONMENT 

• Remote

Here at Allied, we reputed company that great talent can reputed company from reputed company. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for reputed company. To support a smooth and efficient remote work experience, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.

reputed company has reviewed this job reputed company to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of reputed company functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Compensation is not limited to reputed company salary.  Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, reputed company, Life and Disability Insurance, Generous reputed company Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.

Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time.  reputed company applicants acknowledge that by applying to the position you understand that the specific pay reputed company is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process.  It is at reputed company's discretion to determine what pay is provided to a candidate reputed company the reputed company associated with the role.