Claims Associate
Diverse Lynx
Claims Associate (AA Level)
Work Location: Tampa, FL (Remote)
Job Type: Full-time
Qualification: High School Graduate
Experience Required: Minimum 5 years of experience in Claims Processing
Note: Candidates are required to attend a 6 to 8-week on-site training program.
Candidate Specifications
- Should be comfortable working from office
- Typing speed of 25 WPM with 90% accuracy
- Strong knowledge of the healthcare domain, with at least 5 years in healthcare and claims processing
- Minimum 3 years' experience as a Claim Examiner Level III
- Minimum 3 years' experience in Adjustments and Disputes (Appeals)
- Experience working on California Medicaid/Medicare claims
- Understanding of California claims contract language
- Knowledge of CPT and HCPC codes
- Familiar with UB04 & CMS1500 forms
- Basic mathematical skills with the ability to calculate benefits and out-of-pocket amounts
- Experience in Corrected Claims processing
- Ability to coordinate benefits with Medicare/Medicaid
Process Details
- Work Schedule: 5 days working
- Type: Non-Voice / Back Office
- Good typing speed required
Principal Responsibilities
- Medical Claims Processing: Accurately review, verify, and process insurance claims as per company policies and SOPs.
- Documentation Review: Analyze claim documents, medical records, and benefit summaries to determine eligibility and process claims accordingly.
- Customer & Internal Interaction: Communicate with members, healthcare providers, and internal teams to resolve claims and gather required information.
- Data Entry: Enter claim details and maintain accurate records within the claims management system.
- Continuous Improvement: Identify opportunities for process improvement to enhance claims accuracy and efficiency.
Diverse Lynx LLC is an Equal Employment Opportunity employer. All qualified applicants will receive due consideration for employment without any discrimination. All applicants will be evaluated solely on the basis of their ability, competence and their proven capability to perform the functions outlined in the corresponding role. We promote and support a diverse workforce across all levels in the company.
Vacancy posted 3 days ago
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