Senior Claim Benefit Specialist Operations (Encounters)
Core
Researches, reviews, and adjudicates complex, sensitive, and specialized medical encounters and claims in accordance with state-specific processing guidelines.
Role type
Senior claims adjudication specialist
Builds
Accurate claim payments and encounter corrections
Domain
Healthcare insurance / Medicaid and Medicare
Required skills
Medical claims processing, State-specific guideline adherence, Claims system adjudication, Issue escalation, Cross-functional partnership, Procedure development
Preferred skills
QNXT, Facets, Edifecs, Medicaid/Medicare specific experience
Technologies
MS Office Suite (Excel, Word, OneNote), Claims processing systems
Responsibilities
Adjudicate complex claims with accuracy, Meet quality and production expectations, Identify and escalate payment accuracy issues, Partner to resolve encounter acceptance barriers, Contribute to standardized procedures, Balance competing priorities across markets
Seniority
Senior, hands-on IC