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Solis Health Plans · 2 weeks ago

Claims Operations Clerk

Doral, FL, US

Full-time

Onsite

Entry Level

$0/hr - $18/hr

1+ years exp

Solis Health Plans is looking for a Claims Operations Clerk responsible for supporting the Claims Department by reviewing incoming correspondence, managing documentation, and assisting with claims processing in accordance with Plan guidelines. This role requires strong attention to detail, effective communication with providers, and adherence to HIPAA and company standards.

Health CareHealth DiagnosticsPersonal Health

Responsibilities

Review the incoming claim correspondence and determine appropriate next steps

Work within SDS (Smart Data Solutions) to review claims for potential rejection and member eligibility

Create and assign cases to Claims Specialists as needed

Scan, attach, and organize documentation in the system accurately and efficiently

Assist with Maximus case preparation in support of Level 2 appeal submissions

Provide support with recoupment mailings, ensuring accuracy and timely processing

Manage and respond to claim-related email inquiries from providers and internal teams

Handle G&A faxes and claim faxes for disputes and appeals

Process Coordination of Benefits (COB) letters received from members or providers

Support overflow work for the claims department and assist with various ad hoc tasks

Communicate effectively and professionally with providers regarding claim status and issues

Maintain confidentiality and compliance with HIPAA regulations

Qualification

HIPAA regulationsMicrosoft OfficeClerical experienceBilingual (English/Spanish)Work under stressPrioritizeOrganizational skillsCommunication skillsSelf-motivated