WellSense Health Plan · 1 day ago
Claims Adjudicator
Boston, MA
Full-time
Remote
Entry Level
2+ years exp
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Responsibilities
Provide general claims support by reviewing, researching, investigating, processing and adjusting claims.
Identify trends and report to Supervisor as necessary.
Review and analyze data from system-generated reports for in-process claims to identify and resolve errors prior to final adjudication.
Consistently meet established productivity, schedule adherence and quality standards.
Other duties as assigned.
Qualification
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Required
High School Diploma / GED (or higher)
Experience with Microsoft Excel (ability to create, edit, filter and sort through spreadsheets)
Experience with Microsoft Word (ability to create and edit documents)
Experience with Microsoft Outlook (ability to send/receive emails and calendar invites)
Understand and maintain HIPAA confidentiality and privacy standards when completing assigned work
Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
Navigate across various computer systems to locate critical information.
Attention to detail to ensure accuracy, which will support timely processing of the member's claim.
Strong communication skills (internally and externally).
Ability to work with minimal supervision while meeting deadlines.
Regular and reliable attendance is an essential function of the position.
Ability to work OT during peak periods.
Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Ability to keep all company sensitive documents secure (if applicable)
Must live in a location that can receive an approved high-speed internet connection or leverage an existing high-speed internet service
Preferred
Associate degree or some college coursework (preferred)
2+ years of administrative experience (i.e. office, administrative, clerical, customer service, etc.)
1+ years of experience processing medical, dental or prescription claims
Experience with Facets system
Familiarity with UB04’s and CMS 1500’s
Benefits
Full-time remote work
Competitive salaries
Excellent benefits
Company
WellSense Health Plan
A nonprofit health plan serving Medicare, Individual & Family, and Medicaid plan members in Massachusetts & New Hampshire.
1,001-5,000 employees
Funding
Current Stage
Late StageLeadership Team
Heather Thiltgen
President & CEO
Diana Cruz
Chief Operating Officer
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