A health insurance company needs applicants for an opening for a Remote Medicare Corporate Medical Director. Individual must be able to fulfill the following responsibilities: Provide insight and feedback to Group Medicare clients and leadership regarding claims experience.
Core Responsibilities of this position include: Evaluating claims and medical history for our policyholders. Completing any other assigned tasks. Position Requirements Include: Work from home twice a week. Vet tech brain. Knowledge we gained working in practices.
2+ years of medical claims. 2+ years of data analysis experience. 2+ years of experience with claims processing or adjudication systems. Maintaining working knowledge of coding standards, billing rules and regulations. Knowledge of health plan and payment methodology.
A medical insurance company has an open position for a Remote Medical Claims Specialist. Core Responsibilities Include: Confirming coverage and then managing claims and suits brought against policyholders. Selecting legal counsel. Managing the litigation with outside counsel.
Acting as a direct contact and communicate with internal and external Customers and medical providers. Providing appropriate verbal and/or written communication to internal and external Customers. Ensuring that claims are processed consistently and properly.
Completing valuations for corporate and public sector clients. Providing IBNR reserve calculations for self-insured medical plans. Applicants must meet the following qualifications: 5+ years of experience. ASA or better. Ability to sign off on OPEB reports.
5 plus years of experience in underwriting risk selection and risk management. Knowledge of risk factors, particularly medical terms and their effect on assumptions. Heavy experience in workflow system methods, knowledge of successful operation of underwriting. Proficient data entry skills.