REMOTE POSITION / CLAIMS PROCESSOR
Virtual Vocations Inc
To support the claims unit, the full-time remote Claims Specialist III will manage the accurate processing of claims edits, determine primacy for Coordination of Benefits (COB), adjust previously paid claims, and resolve complex cases while ensuring compliance with regulations and high levels of member/provider satisfaction.
Key responsibilities
Accurately process complex claims and adjustments, including escalated cases and special projects, to meet contractual obligations
Analyze and resolve problem cases, ensuring proper order of benefits and executing recovery processes for overpaid claims
Assist in training staff, developing system changes, and communicating with internal and external stakeholders regarding claims processing
Required qualifications
High School Diploma or equivalent required
4 years of experience in Coordination of Benefits (COB) or adjustments/refunds processing required
Self-funded processing experience preferred
Strong background in claims coding, processing, and adjustments
Full understanding of claims procedures and primacy rules necessary
Vacancy posted 4 days ago
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