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  • Braintree, MA
  • Andrea Baratz

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Kelly Services is seeking Permanent Insurance Investigator Medical Claims clerks

Kelly Services • Braintree, MA

Posted 7 days ago

Job Snapshot

Travel - None
Degree - 2 Year Degree
Other Great Industries
Customer Service


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Job Description

Kelly Services is seeking Permanent Insurance Investigator Medical Claims Settlement Specialists at a Top Organization in Braintree! Summary of Position: To negotiate settlement with facilities and providers on a national basis to reduce healthcare claims cost. The ideal candidate is an experienced claims negotiator and is highly skilled in working with facilities, physicians, ambulatory surgical centers and helping guide patients relating to claims issues. The candidate should be familiar with CMS-1450 and CMS-1500 forms, all the data elements, and comfortable with claim benchmarks like Medicare and costs. This position requires someone that is self-motivated, proactive, persuasive, persistent, respectful, and assertive. The candidate must be comfortable multi-tasking and possess strong communication skills, both oral and written. ROLES AND RESPONSIBILITIES: - Manage a daily running inventory of unpaid claims or claim disputes - Review and prioritize claims based on processing criteria, timelines, client demands, service level standards, etc. - Review claims and plan language and determine the best way to engage the healthcare provider - Contact facilities and providers to discuss charge adjustments and rationale while obtaining - Signed, agreements for reimbursement - Contact facilities and explain benefits to resolve payment disputes - Work with legal department to ensure escalation of claims - Participate in on-going process improvement to develop efficiencies that streamline the claim - Settlement - Ability to properly handle confidential information in accordance with the Health REQUIRED QUALIFICATIONS: - Preferred: Baccalaureate degree (BA/BS) from an accredited college or university. - Preferred: Minimum of three years' experience in a medical healthcare claims role dealing with - Facilities, providers and members is required. - Background in healthcare claims management environment including provider negotiation, - Hospital billing, claims adjudication and administration or the ability to interpret benefit plans. - Two year(s) minimum insurance company/TPA/hospital experiences, with emphasis in Claims, fee schedules, contracting, and/or external vendor relationship management preferred - PC literate, including Microsoft Office products and web based application Please send resumes to [Click Here to Email Your Resumé] for consideration
Job ID: US3219AB_22777707
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