Claims Resolution Specialist

Details

• Department: Insurance

• Schedule: Full-Time, 8am - 5pm, Mon-Fri, fully remote

• Facility: Automated Benefit Services (ABS)

Benefits

Paid time off (PTO)Various health insurance options & wellness plansRetirement benefits including employer match plansLong-term & short-term disabilityEmployee assistance programs (EAP)Parental leave & adoption assistanceTuition reimbursementWays to give back to your community

As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.

*Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: PRN, Short-Term Option, etc.). Connect with your Talent Advisor today for additional specifics.

Responsibilities

As a Claims Resolution Specialist, you'll handle complex claims and ensure client, provider, external and internal claims inquiries are researched and resolved.

• Review and respond to escalated internal and external calls and emails from participants, providers and provider reps.

• Review provider fee schedules to resolve payment discrepancies on behalf of providers referred to this area by the provider relations team or the client.

• Review medical records and physician notes.

• Work closely with the claims and adjustment team to have claims reprocessed.

• Pay complex claims; specifically transplant and high dollar claims.

• Research root cause issues and deliver resolutions to the client.

• Generate impact reports to analyze and troubleshoot errors with provider fee schedules and claims processing errors when referred by the claims department, customer service, leadership, provider relations team or the client.

• File appeal approvals with DIFS complaints with compliance on issues reported to the Attorney General's Office.

• Strong Knowledge of healthcare claims, Medicaid, Medicare, Pharmacy benefits, etc.

Requirements

Education:

• High School diploma equivalency with 2 years of cumulative experience OR Associate's degree/Bachelor's degree OR 4 years of applicable cumulative job specific experience required.

Additional Preferences

Additional Preferences:

• Strong CLAIMS background, preferred

• Complex Medical Claims experience, preferred

• 5 years of healthcare experience, preferred

Why Join Our Team

Ascension associates are key to our commitment of transforming healthcare and providing care to all, especially those most in need. Join us and help us drive impact through reimagining how we can deliver a people-centered healthcare experience and creating the solutions to do it. Explore career opportunities across our ministry locations and within our corporate headquarters.

Ascension is a leading non-profit, faith-based national health system made up of over 150,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

Equal Employment Opportunity Employer

Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.

For further information, view the EEO Know Your Rights (English) (~~~) poster or EEO Know Your Rights (Spanish) (~~~) poster.

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Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

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