Apply on Employer Site

CareMore Health · 12 hours ago

Claims Support Specialist II

Chicago, IL

Full-time

Onsite

Mid Level

$22/hr - $33/hr

4+ years exp

CareMore Health is focused on improving the healthcare experience, and they are seeking a Claims Support Specialist II to join their Payment Integrity team. This role involves auditing claims for overpayments, working with vendors for validation, and ensuring the accuracy of departmental procedures.

Health CareMedicalPersonal HealthService Industry

Responsibilities

Audits paid claims for overpayments using various techniques including systems based queries, specialized reporting, or other research. Interacts with staff and management from other departments on a regular basis to ensure customer satisfaction

May work with recovery and collection vendors to validate overpayments, validate vendor invoices and provide feedback to modify queries when needed

Works closely with contract managers to identify and correct contractual issues, if applicable

Handles complex case research and resolution

May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash and accounts receivable processes and all other cash applications as required

May review and monitor associates work for quality standards

May review department policy and procedure manuals for accuracy and works to ensure procedures and polices are accurate and complete

Assists in special projects to find and prevent overpayments and to identify process improvements

Completes special projects as assigned with minimal supervision

Researches voluntary refunds for accuracy

Requires accurate balancing of all accounts

Qualification

Claims processingCustomer serviceAuditingResearch skillsProcess improvement

Required

Requires a H.S. diploma; 4-5 years of claims processing and/or customer service experience; or any combination of education and experience, which would provide an equivalent background