Overview: Our client is seeking two contract-to-hire professionals to join their team as Claims Investigators / Process Specialists. These roles are pivotal in ensuring the accuracy and efficiency of claims processing.
Key Responsibilities:
-Develop Solutions: Create and implement processes to address overpaid claims challenged by providers.
-Investigate Claims: Thoroughly review and document claims that have been disputed.
-Collaborate: Work closely with the claims team to analyze data and temporarily halt reprocessing during investigations.
-Track Progress: Maintain detailed records of investigations using Excel.
-Strategize: Move forward with retractions and develop strategies to prevent future errors.
-Communicate: Present ideas and updates to leadership and team members to enhance processes.
-Pay rate between $20-38/hr depending on experience
We are a company committed to creating inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity employer that believes everyone matters. Qualified candidates will receive consideration for employment opportunities without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, disability, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to
HR@insightglobal.com. The EEOC "Know Your Rights" Poster is available
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-Experience: Proven background in claims investigation within a health plan or healthcare setting.
-Negotiation Skills: Experience in negotiating payment agreements with providers.
Technical Proficiency: Proficient in Microsoft Word and Excel.
-Organizational Skills: Strong ability to organize and document information effectively.
-Team Collaboration: Excellent communication and collaboration skills with teams and leadership.
- Qnxt Experience: Familiarity with Qnxt software is a plus.
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.