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Claims Representative (Healthcare)

Orlando, FL 32804

Post Date: 04/25/18 Job ID: 44842 Industry: Claims Administrator

This Fortune 500 client is a nation-wide leader in the healthcare services field and they pride themselves on their ability to provide a wide range of government sponsored healthcare programs; including a variety of insurance solutions. Currently, they are seeking a Healthcare Claims Representative to Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues

Position: Direct

Location: Maitland, FL

Similar positions: Claims Liason, Healthcare Clerk, Billing Clerk

Responsibilities Include
  • Review Claims and submit for corrections
  • Rearch Claims to determine eligibility and Identify authorization issues and trends
  • Identify system changes and work with manager in order to implement
  • Oversee plan provider resolution projects
  • Document eligibility issues and assist to create process changes
  • Produce provider claims report and analyze trends

Requirements:
  • High school diploma or equivalent.
  • 3+ years of claims processing, provider billing, or provider relations experience, preferably in a managed care environment.
  • Proficient in Excel and Microsoft Office Suite
  • CPC certification required
  • Knowledge of provider contracts/reimbursement interpretation preferred.
  • Applicants must be currently authorized to work in the United States on full-time basis

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