Claims Processor

Job Description

Job Description

Marpai Administrators is a technology company transforming the Third-Party Administration sector serving employers with self-funded health plans. Marpai Administrators (Marpai) is an AI-powered national TPA (third party administrator) using deep learning and machine learning to maximize population health outcomes with the greatest cost efficiency for any health plan budget. We create healthier members and a healthier bottom line. Marpai proactively targets at-risk members with meaningful clinical interventions to improve outcomes.

ABOUT THE POSITION:
The Claims Processor will be responsible to for reviewing claims for accuracy, completeness, and eligibility. The Claims Processor is responsible to adjudicate claims, complete work assignments and meet established departmental metrics.

WHAT YOU WILL BE DOING:

• Data entry of claims into system.
• Review, analyze adjudicate claims
• Validate the information on all claims to ensure there is no missing or incomplete information
• Ability to understand and apply benefits as outlined in plan document
• Maintain/manage all claim inventories in accordance with health plan and regulatory policies
• Display maturity, composure and ability to operate under stressful conditions.
• Complete daily assignments and update required spreadsheet
• Complete end of day summary
• Flexibility to change work direction as determined by management
• Meet departmental standards for quality, production and attendance.
• Analyst is flexible and able to commit to overtime based on business needs
• Other duties as required

WHAT DO YOU NEED

• Associates degree preferred
• 2+ yrs claims processing
• Strong analytical, research, and communication skills.
• Expansive knowledge of medical terminology.
• Excellent verbal and written communication skills as well as exemplary organizational skills.
• Work closely with leadership to assist in mitigating trends as necessary.
• Independent judgment in decision-making and problem solving.
• Computer skills in MS Word, Excel, PowerPoint, & Outlook at the intermediate or higher level.
• Ability to multi-task & anticipate potential needs/problems.
• Strong attention to detail.
• Ability to understand and apply on-line documentation policies and procedures.
• Excellent customer services skills including an ability to follow through, take ownership and drive all assigned tasks to completion.
• Ability to handle large volumes of work, solve problems and manage multiple assignments while meeting critical deadlines.
• HIPAA Compliance

WORK REQUIREMENTS:

• Fast paced, dynamic work environment requiring the ability to be adaptive, innovative and flexible
• Travel minimal

WHY WORK AT MARPAI?
We have great benefits:

• Generous PTO
• Medical and Prescription
• EAP
• FSA / HSA / Dependent Care
• Dental
• Vision
• Life and Disability
• STD/LTD
• Voluntary Benefits: Critical Illness, Accident, Hospital
• 401k with Employer Match
• LegalShield
• Identity Theft Protection

Marpai is an equal opportunity workplace. We are committed to equal opportunity regardless of race, color, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, or veteran status.

This is a remote position.