Job Description
Role Overview:
- Compensation: Competitive hourly rate of $30/hour
- Company: Workwarp (representing Aeetna)
- Start Date: Immediate openings available
- Location: Remote
- Position: Remote Claims Adjuster
At Workwarp, we believe in empowering individuals to make a real difference. As a Remote Claims Adjuster, you'll play a vital role in ensuring accessible, affordable, and personalized healthcare. You'll contribute to a positive impact on people's lives by expertly handling claims and providing exceptional service.
Responsibilities:
- Review and process claims, ensuring accuracy and adherence to established guidelines.
- Investigate and resolve complex, sensitive, and unique claims according to guarantee handling rules.
- Negotiate supplier discounts and manage returns.
- Respond to customer inquiries and resolve issues with professionalism and efficiency.
- Apply technical and guarantee handling skills across all dollar levels of customer support platforms.
- Utilize clinical need guidelines to determine coverage, verify eligibility, identify discrepancies, and apply cost control measures.
- Perform guarantee re-work calculations and resolve claim excesses, underpayments, and anomalies.
- Manage complex, non-routine supplier discounts and inquiries.
- Review and interpret clinical agreement language to identify potential overpayment opportunities.
- Handle phone and written requests related to pre-endorsements, re-evaluations, and other inquiries.
- Ensure all consistency requirements are met and payments are processed according to company policies and procedures.
- Review and address relevant communications to the team that may impact claims.
- May provide mentorship and guidance to less experienced team members.
- Utilize available resources to manage workload and meet deadlines.
Qualifications:
- Prior experience in a fast-paced production environment.
- Proven ability to manage multiple tasks with accuracy and efficiency.
- Excellent written and verbal communication skills, with strong interpersonal abilities.
- Experience in claims handling is essential.
Desired Skills:
- Experience with DG system claims processing.
Ready to Apply?
If you are a motivated and detail-oriented individual eager to contribute to a dynamic team, we encourage you to apply! We look forward to reviewing your application.
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