Claims Representative

Title: Claims Resolution Representative - Payor Side experience in MUSTFor these Claims Resolution Representative positions, our preference is to identify candidates with direct health plan or payer-side experience. Ideally, they would have experience processing, reviewing, adjudicating, researching, or resolving claims that are received from providers, rather than primarily supporting providers who are following up on claims with health plans.OverviewThe Claims Resolution Representative plays a vital role in ensuring accuracy and adherence to the applicable guidelines. This position serves as a crucial liaison between members, providers, agencies, and the internal claims department, demonstrating leadership, collaborative skills, and commitment to achieving results.Skills & Experience• High School Diploma or GED.• 1+ years of experience conducting research to resolve issues within the healthcare field.• Ability to maneuver through various computer claims and eligibility platforms simultaneously• Outstanding customer satisfaction skills.• Must be firm but professional when interacting with contacts while performing tasks.• Friendly personality, tact, patience, empathy, and a helpful yet professional attitude are essential.• Strong computer skills, including proficiency in MS Word and Excel.• Excellent oral and written communication skills.• Excellent organization and time management skills, with the ability to establish priorities effectively.• Ability to read, write, and follow directions.• Self-directed and capable of working without direct supervision.• Ability to collaborate effectively with others.• Create and maintain a positive atmosphere, demonstrating leadership qualities.• Knowledgeable in claims review and analysis