Senior Claim Benefit Specialist Operations (Encounters)
Core
Researches, reviews, and adjudicates complex, sensitive, and specialized medical encounters to ensure accurate claim payments in accordance with state-specific guidelines.
Role type
Senior Claims Adjudication Specialist
Builds
Accurate claim payments and encounter corrections
Domain
Health Insurance / Medicaid & Medicare
Required skills
Medical claims processing, State-specific guideline adherence, Claims system adjudication, Issue escalation, Cross-functional partnership, Desktop development, Priority balancing
Preferred skills
QNXT, Facets, Edifecs, Medicaid/Medicare specific experience
Technologies
MS Office Suite (Excel, Word, OneNote), Claims processing systems (QNXT, Facets, Edifecs)
Responsibilities
Adjudicate complex claims with accuracy, Identify and escalate issues impacting payment accuracy, Partner cross-functionally to resolve barriers, Contribute to development of desktops and standardized procedures, Balance competing priorities across multiple markets, Engage in working sessions to advance KPIs
Seniority
Senior, hands-on IC