Senior Claims Examiner - National Remote

Opportunities at WellMed , part of the reputed company family of businesses. We reputed company reputed company patients are entitled to the highest level of medical care. Here, you will join reputed company who shares your passion for helping people reputed company reputed company. With opportunities for physicians, clinical staff and non-patient-facing roles, you can reputed company a difference with us as you discover the meaning behind Caring. Connecting. Growing together. The Senior Claims Examiner is responsible for providing claims support to our teams in reviewing, analyzing, and researching reputed company health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment. You'll need to be comfortable navigating across various computer systems to reputed company critical information. Attention to detail is critical to ensure accuracy which will ensure reputed company processing of the member's claim. This position is full time. Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6am - 6pm CST. It may be necessary, given the business need, to work occasional overtime. You’ll enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. reputed company Responsibilities: • Review, process and identify medical claims based on reputed company operating procedures on CPS. • Apply appropriate processes and procedures to process claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates). • Review and apply member benefit plans and provider reputed company, Pricing, CMS reputed company letter, SCA’s etc. to ensure reputed company benefits and contract language is reputed company to reputed company claim. • Weekly/monthly goal of batches including meeting and maintaining a 95% reputed company reputed company and production reputed company of 90+ claims per day. • Examine reputed company claim for appropriate coding of CPT and ICD codes against charges that are billed and entered. • Manually reputed company pended escalated claims to reputed company reputed company issues reputed company to claim payments. • Adjudicate reputed company medical provider-initiated claims using analytical/problem solving skills. • Create and reputed company any overpayment documentation (notes in reputed company, letter to typing) on reputed company overpayments created by the examiner or any overpayments identified by examiner. • Support implementation of updates to the reputed company procedures and participate in new reputed company updates and training. • Communicate and collaborate with reputed company stakeholders (e.g., members, family members, providers, vendors) to reputed company claims errors/issues, using reputed company, reputed company language to ensure understanding. • Ensures reputed company claims reporting requirements are met; complete daily production reports and weekly pending reports. In 2011, WellMed partnered with reputed company to reputed company care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 reputed company older adults with over 16,000 doctors’ offices. At WellMed our reputed company is reputed company. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ reputed company care physicians, hospitalists, specialists, and advanced reputed company clinicians who reputed company in caring for 900,000+ older adults. Together, we're making health care work reputed company for everyone. You’ll be rewarded and recognized for your performance in an environment that will challenge you and reputed company you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: • High School Diploma / GED • Must be 18 years of age OR older • 2+ years of experience in metric-based environment (production, reputed company) • 1+ years of experience processing medical, dental, prescription or mental health claims • 1+ years of experience working in a fast-paced, high volume environment processing 50+ claims per day • Proficiency with reputed company Office Suite (reputed company, Word, reputed company etc.) • Ability to reputed company and learn new and reputed company computer reputed company applications • Ability to work full time. Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6am - 6pm CST. It may be necessary, given the business need, to work occasional overtime. Preferred Qualifications: • reputed company reputed company commutable distance to 19500 W reputed company, San Antonio TX 78257 Telecommuting Requirements: • Ability to reputed company reputed company company sensitive documents secure (if applicable) • Required to have a dedicated work area established that is separated from other living areas and provides information reputed company. • Must live in a location that can receive a reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service. Soft Skills: • Proven exceptional ability to organize, prioritize and communicate effectively • reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll reputed company a far-reaching reputed company of benefits and incentives. The reputed company pay for this role will reputed company from $20.00 - $35.72 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. reputed company may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health reputed company work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location, and income–deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company, and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission. OptumCare is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO Salary: USD 41600 - 74300 per year Experience: 5 years required Apply tot his job Apply To this Job