Claims Processing Specialist Position Available In Fulton, Georgia
Tallo's Job Summary: A Claims Processing Specialist at FIRSTENROLL LLC in Alpharetta, GA, reviews, evaluates, and investigates healthcare insurance claims for accuracy and compliance. Responsibilities include adjudication based on plan documentation, maintaining detailed records, ensuring compliance with policies, providing customer service, detecting fraud, and continuous learning. Qualifications include experience in healthcare insurance, strong analytical skills, attention to detail, communication abilities, and technical proficiency in insurance software.
Job Description
Claims Processing Specialist
FIRSTENROLL LLC 12660
Crabapple Rd # B, Alpharetta, GA 30004
Location:
Alpharetta In Office Job Overview:
A Healthcare Claims Processing Specialist plays a crucial role in the insurance industry, ensuring that claims are handled efficiently and accurately. Here’s a detailed description of the role:
Claims Processing Specialist Responsibilities:
Review and Evaluate Claims :
Assess all types of healthcare insurance claims for accuracy and completeness.
Investigate Claims :
Analyze details to determine the level of liability, often involving communication with policyholders, claimants, and healthcare providers. Adjudicate Based on
Plan Documentation :
Work with plan documentation to adjudicate based on plan summary of coverages.
Documentation :
Maintain detailed records of all claim activities for review and auditing purposes.
Compliance :
Ensure all actions comply with company policies and legal requirements.
Customer Service :
Provide high levels of customer service by answering questions and providing information to all parties involved in the claims process.
Fraud Detection :
Identify and investigate potential fraudulent claims.
Continuous Learning :
Stay updated with changes in regulations, best practices, and industry trends.
Qualifications:
Experience :
Proven experience in a similar role within the healthcare insurance industry.
Skills :
Strong analytical, problem-solving, and negotiation skills. Detail-orientation a must. Excellent communication and customer service abilities.
Technical Proficiency :
Familiarity with insurance software and digital claim processing tools.
