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We are seeking a dedicated Senior Process Executive - HC with 1 to 3 years of experience in Claims Adjudication. The ideal candidate will have expertise in Medicare and Medicaid Claims and it is advantageous if they also have experience in Commercial Claims. This is a work-from-home position with night shifts.
Responsibilities
Process and adjudicate Medicare and Medicaid claims efficiently and accurately.
Ensure compliance with all relevant regulations and guidelines.
Analyze and resolve claim discrepancies and issues promptly.
Collaborate with team members to improve claim processing workflows.
Maintain up-to-date knowledge of industry standards and changes.
Provide exceptional customer service to internal and external stakeholders.
Utilize technical skills to enhance claims adjudication processes.
Monitor and report on claim processing metrics and performance.
Identify and implement process improvements to increase efficiency.
Conduct regular audits to ensure accuracy and compliance.
Train and mentor junior team members on claims adjudication processes.
Communicate effectively with other departments to resolve claim issues.
Participate in continuous learning and development opportunities.
Qualifications
Possess strong technical skills in claims adjudication.
Have in-depth knowledge of Medicare and Medicaid claims.
Experience in Commercial Claims is a plus.
Demonstrate excellent analytical and problem-solving abilities.
Exhibit strong attention to detail and accuracy.
Show proficiency in relevant software and tools.
Display effective communication and teamwork skills.
Maintain a high level of professionalism and integrity.
Be adaptable to night shifts and work-from-home model.
Have a proactive approach to learning and development.
Demonstrate the ability to work independently and manage time effectively.
Show commitment to delivering high-quality work consistently.
Possess a customer-focused mindset and dedication to service excellence.
