REMOTE POSITION / CLAIMS PROCESSOR

This position operates on a hybrid work schedule. Clever Care was created to meet the unique needs of the diverse communities we serve. Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.Job SummaryUnder close supervision, Claims Examiner I process non-complex paper or electronic claims, handling from inception to conclusion within established authority and guidelines.This position requires considerable interaction with clients, claimants on the phone, with management, other Claims Examiners, and other staff in the office; therefore, consistently being at work in the office or home office location as applicable, in a timely manner, is inherently required of this position.Functions & Job Responsibilities· Be familiar and comply with all company policies and procedures.· Effectively manages a caseload of 50-150 claims a day· Initiates and conducts claim investigation in a timely manner.· Achieve claims processing standards for accurate and timely claims adjudication.· Maintain claims processing standards to meet performance appraisal goals.· Determines compensability of claims and administer benefits, based upon product benefits and CMS guidelines.· Manages medical treatment and medical billing, authorizing as appropriate, with requests for surgical treatment to be referred to supervisor prior to authorizing.· Communicates with provider regarding claims issues· Computes and processes payment.· Finalizes all claims and obtains authority as designated.· Communicates appropriate information promptly to the client to resolve claims efficiently.· Adheres to all Company policies and procedures.· Performs other duties as assigned to include but not limited to assisting Document Processing Associate.· Bachelor’s degree in related field preferred· One (1) year related experience; Skills:· Technical knowledge of statutory regulations and medical terminology.· Familiar with CMS claims payment, billing guidance.· Strong analytical skills, including the ability to analyze and organize data.· Excellent organizational, oral presentation and written and verbal communication skills· Proficiency in MS Office products, including PowerPoint, Excel, and WordWage Range: $27.00 to $32.00 per hourPhysical & Working Environment.Must be able to travel when needed or required• Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)• Ability to sit for long periods; Work is performed in an office environment and/or remotely. May occasionally be required to work irregular hours based on the needs of the businessClever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. J-18808-Ljbffr Clever Care Health Plan