Claims Resolution Specialist

: Overview: As a department the team works multiple functions (Out of Network, Appeals, and CSC corrections impacting Providers, Clients and/or Patients) this position receives internal/external requests and responds to request by using remediation processes governed by CareCentrix and Health Plan processes and guidelines. The role works cross functionally with other CareCentrix departments to determine correct actions, and responses. The role will have knowledge of CSC, RCM and Health Plan functionalities in order to correctly review and complete work. Responsibilities: In this role, you will:

• Must have a strong understand of at least one of the Claims Resolution Responsibilities; Out Of Network Processing, Appeals, and Intake/Authorization Remediation (1.0 and/or 2.0 Claims processes
• Handles various communication channels with providers, including inbound and outbound provider calls which involve researching, resolving, and documenting issues.
• Analyzes data and determines if CareCentrix claims processing guidelines have been followed correctly by researching plan, eligibility, and patient authorization information.
• Tracks errors within CareCentrix processing that could involve; claims, intakes, and/or authorizations. Is able to communicate to up-line management for coaching and training purposes.
• Accurately identifies opportunities and escalates accordingly.
• Participates in and contributes to performance improvement activities.
• Participates in special projects and performances other duties as assigned.

Qualifications: You should reach out if you have:

• High School Diploma/GED or two years of customer service, claims processing, medical terminology, medical services or equivalent experience required.
• Minimum one year of experience within CareCentrix with an understanding of full process functionality.
• Knowledge of basic spreadsheet / word processing / data entry and basic math skills required.
• Knowledge of Claims Management, Health Plan Verification, Authorization Creation and URAC standards preferred.

What we offer:

• Starting Pay for external hires is $18.00/ hour + Incentive Bonus Opportunity. The pay range included in this posting reflects future growth / earning potential.
• Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match
• Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more
• Advancement Opportunities, professional skills training, and tuition /exam reimbursement
• PayActiv - access earned income in between pay checks
• Walgreens Discount - receive up to 25% off eligible items
• Great culture with a sense of community

CareCentrix maintains a drug-free workplace #IDCC

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.