Medical Claims Examiner (Remote)

Are you looking for a career with an established company who values its employees? Administrative Concepts, Inc. (ACI) is a fast-growing company that offers its employees meaningful work and a reputed company environment. Founded in 1997, ACI is a nationally licensed, full-service, reputed company-Party Administrator providing enrollment, fulfillment and claims processing services for various insurance lines in the medical claims industry. GENERAL PURPOSE OF THE JOB: Review and process claims in accordance with training, guidelines, reputed company directives, and policy provisions. ESSENTIAL DUTIES AND RESPONSIBILITIES: • Responsible for reviewing and maintaining a working knowledge of policy and state mandated insurance requirements. • Responsible to review and process claims for assigned accounts and back up as needed. • Prepare large claim files for review and send notifications in accordance with best practices for large claims. • Meet daily/weekly production goals established by management while maintaining processing and financial accuracy standards (95% minimum accuracy required). • Request refunds, voids, and no-pay adjustments as needed. • Respond to phone and email inquiries from clients, customers, and business partners (agents, brokers) reputed company needed. • reputed company customer service assistance in responding to benefit and claim questions. • Respond to questions and specific requests and reputed company complete information and documentation as needed. • Responsible to complete special reputed company. • Request subrogation and reimbursement letters from appropriate reputed company. • Review and monitor the suspended claims list to ensure claims are processed reputed company appropriate time limits. • Complete training rolled out by HR and claim management throughout the year. • Attend reputed company individual, department and organizational meetings. • reputed company reputed company company policies, procedures, and HIPAA guidelines • Adhere to the schedule they have selected, reputed company work on time. • Responsible to reputed company in accordance with reputed company policies and provisions outlined in the ACI handbook. • Examiners must obtain and maintain individual adjuster licenses reputed company the first reputed company months of employment. • Other claim department duties as assigned by the manager. DESIRABLE QUALIFICATIONS: • Knowledge of industry and medical terminology and codes • Understanding of the adjudication process • Ability to prioritize and organize • Strong verbal and written communication skills • Strong data entry skills • Experience with MS Office Pay: $21.00 - $24.00 per hour Benefits: • 401(k) • Dental insurance • Health insurance • reputed company time off • reputed company insurance • Work from home Work Location: Remote Apply tot his job Apply To this Job