- Determines coverage for medical, dental, and vision procedures by studying provisions of the member's health policy
- Extracts additional information as required from outside sources, including claimant, physician, employer, hospital, insurance carriers, and other third partners
- Initiates investigation of questionable claims
- Resolves medical, dental, and vision claims and billing questions and issues by
- examining the summary of benefits
- contacting the carrier and/or the provider billing office to ensure the member is not being overcharged
- calculating out-of-pocket costs based on benefits
- initiating reimbursement requests with the carrier
- composing appeal letter
- Provides information on year-to-date deductible, copay, and coinsurance activity to team members
- Maintains quality customer service by following customer service practices and responding to customer inquiries in a timely manner
- Protects claimant information by following HIPAA guidelines
- Reports claim status updates in proprietary CRM and provides detailed information on each claim
- Strong communication skills, both written and verbal
- Professional experience with both benefit plan interpretation, provider billing practices, and claim adjudication
- Strong demonstration of critical thinking and problem-solving skills
- Bachelor's degree in health sciences or related field and minimum of 2 years of experience as a medical claims specialist preferred
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Senior Claims Specialist
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Summit Consulting Denver, United StatesSenior Claims Specialist - CO Workers' Compensation page is loaded · Senior Claims Specialist - CO Workers' Compensation · Apply · remote type · Remote · locations · Colorado, USA · time type · Full time · posted on · Posted 4 Days Ago · job requisition id · R5473 · ...
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General Search & Recruitment Denver, United StatesJob Description · Job DescriptionTechnical Claims Specialist · Denver, CO · A well-respected Insurance Carrier is seeking a qualified and experienced Technical Claims Specialist to join our dynamic team. · As a Technical Claims Specialist, you will play a crucial role in managing ...
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Markel Service Inc. Denver, United States Full timeWhat part will you play? If you're looking for a place where you can make a meaningful difference, you've found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and ...
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Innova Solutions Wheat Ridge, United StatesInnova Solutions is immediately hiring for a Claims Specialist · Position type: Contract · Duration: 6 months · Location: Must be located in Denver metro area* The first day of orientation is onsite and there may be some aspects of training that may need to be done in person ...
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Technical Claims Specialist
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Capstone Search Group Denver, United States Full timeAbout the Role · Respected specialty carrier offers unique insurance products and services tailored to the needs of niche industry segment. Currently seeking experienced Technical Claims Specialists. · Positions could be located either in Houston or Denver with a preference towar ...
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Claims Administrative Support Specialist
2 weeks ago
Progressive Insurance Denver, United StatesJoin Forbes' 2024 Best Employer for Diversity · As a claims administrative support specialist, you'll play a vital role supporting our claims branch offices. In addition to ensuring essential administrative functions run smoothly, you may also interact with customers and medical ...
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Claims Administrative Support Specialist
3 weeks ago
Progressive Insurance Denver, United StatesJoin Forbes' 2023 Best Employer for Diversity · As a claims administrative support specialist, you'll play a vital role supporting our claims branch offices. In addition to ensuring essential administrative functions run smoothly, you may also interact with customers and medical ...
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Healthcare Billing Claims Specialist
3 weeks ago
Sandstone Care Denver, United StatesPosition: Healthcare Billing Claims Specialist · Location: Denver, Colorado · Schedule: Monday to Friday | 8:30am to 5:30pm · Employment Type: Full-time · Compensation: $19-23 Per Hour (Based on Experience) + Bonuses · Benefits: Medical, Dental, Vision | Short/Long Term Dis ...
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Claims Administrative Support Specialist
3 weeks ago
Progressive Insurance Denver, United StatesJoin Forbes' 2024 Best Employer for Diversity · As a claims administrative support specialist, you'll play a vital role supporting our claims branch offices. In addition to ensuring essential administrative functions run smoothly, you may also interact with customers and medical ...
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Healthcare Billing Claims Specialist
1 week ago
Sandstone Care Denver, United StatesJob Description · Job DescriptionPosition: Healthcare Billing Claims Specialist · Location: Denver, Colorado · Schedule: Monday to Friday | 8:30am to 5:30pm · Employment Type: Full-time · Compensation: $19-23 Per Hour (Based on Experience) + Bonuses · Benefits: · Medical, Dent ...
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Senior Commercial Litigation Claims Specialist
3 weeks ago
KING'S INSURANCE STAFFING LLC Denver, United StatesOur client is seeking to add a Senior Commercial Litigation Claims Specialist with an emphasis on handling Employment Practices Liability claims. This person would be responsible for handling complex litigated and non-litigated claims, including but not limited to, discrimination ...
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Claims Specialist
6 days ago
Akkodis Westminster, United StatesAkkodis is seeking a Customer Claims Representative for a 5-month contract (Potential extension and conversion based on performance and business need) Position with a client located in Westminster, CO. Ideally, we are looking for a candidate with experience in customer service, d ...
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Part D Claims Eligibility Specialist
2 weeks ago
InnovAge Denver, United StatesResponsibilities: · The Part D Claims Eligibility Specialist is responsible for performing a range of tasks related to claims and compliance for the InnovAge Part D plan. This includes managing and reconciling Part A claims and stays, managing participant plan enrollment status ...
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Part D Claims Eligibility Specialist
2 weeks ago
InnovAge Denver, United StatesResponsibilities: · The Part D Claims Eligibility Specialist is responsible for performing a range of tasks related to claims and compliance for the InnovAge Part D plan. This includes managing and reconciling Part A claims and stays, managing participant plan enrollment status ...
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Senior Commercial Litigation Claims Specialist
2 weeks ago
King's Insurance Staffing Denver, United StatesOur client is seeking to add a Senior Commercial Litigation Claims Specialist with an emphasis on handling Employment Practices Liability claims. This person would be responsible for handling complex litigated and non-litigated claims, including but not limited to, discrimination ...
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Restoration Claims Specialist
2 weeks ago
SERVPRO of North Thornton/Brighton Commerce City, United StatesJob Description · Job DescriptionBenefits:401(k) matching · Company parties · Competitive salary · Dental insurance · Employee discounts · Health insurance · Opportunity for advancement · Paid time off · Training & development · Vision insurance · Lets get right to it work is bet ...
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medical claims specialist
1 day ago
BrightSpring Health Services Englewood, United States· MEDICAL CLAIMS SPECIALIST · Job Locations · US-CO-ENGLEWOOD · ID · Line of Business · Amerita · Position Type · Full-Time · Pay Min · USD $17.35/Hr. · Pay Max · USD $26.00/Hr. · Our Company · Amerita · Overview · Come join our closed-door specialty infusion pharmacy Amerita i ...
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Senior Technical Claims Specialist
1 day ago
Berkley Englewood, United StatesCompany Details: · Berkley Oil & Gas, (a W.R. Berkley Company) is an insurance underwriting manager providing unique property and casualty products and risk services to customers engaged in the energy sector. Our customers recognize the importance of the expertise we provide and ...
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Insurance Claims Specialist
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MYR Group Thornton, United StatesAbout the Role: · The Insurance Claims Specialist is primarily responsible for coordinating and administering the company's casualty and property insurance claims. The Insurance Claims Specialist will be responsible for the daily management and coordination of Workers Compensati ...
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Claim Operations Specialist
3 weeks ago
Travelers Insurance Centennial, United States OTHERWho Are We? · Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture ...
Billing and Claims Specialist - Denver, United States - Rightway Inc
Description
WHAT YOU'LL DO:Our Navigation Operations is a fast-paced, dynamic, and growing environment. We are looking for individuals who are passionate about concierge service delivery and changing the healthcare experience for consumers.
ABOUT RIGHTWAY:
Rightway is on a mission to harmonize healthcare for everyone, everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient's care journey through a modern, mobile app. Rightway is a front door to healthcare, giving patients the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them.
Since its founding in 2017, Rightway has raised over $130mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global at a valuation of $1 billion. We're headquartered in New York City, with a satellite office in Denver. Our clients rely on us to transform the healthcare experience, improve outcomes for their teams, and decrease their healthcare costs.
HOW WE LIVE OUR VALUES TO OUR TEAMMATES:
We're seeking those with passion for healthcare and relentless devotion to our goal. We need team members that embody our following core values:
1) We are human, first
Our humanity binds us together. We bring the same empathetic approach to every individual we engage with, whether it be our members, our clients, or each other. We are all worthy of respect and understanding and we engage in our interactions with care and intention. We honor our stories. We listen to-and hear-each other, we celebrate our differences and similarities, we are present for each other, and we strive for mutual understanding.
2) We redefine what is possible
We always look beyond the obstacles in front of us to imagine new solutions. We approach our work with inspiration from other industries, other leaders, and other challenges. We use ingenuity and resourcefulness when faced with tough problems.
3) We debate then commit
We believe that a spirit of open discourse is part of a healthy culture. We understand and appreciate different perspectives and we challenge our assumptions. When working toward a decision or a new solution, we actively listen to one another, approach it with a "yes, and" mentality, and assume positive intent. Once a decision is made, we align and champion it as one team.
4) We cultivate grit
Changing healthcare doesn't happen overnight. We reflect and learn from challenges and approach the future with a determination to strive for better. In the face of daunting situations, we value persistence. We embrace failure as a stepping stone to future success. On this journey, we seek to act with guts, resilience, initiative, and tenacity.
5) We seek to delight
Healthcare is complicated and personal. We work tirelessly to meet the goals of our clients while also delivering the best experience to our members. We recognize that no matter the role or team, we each play a crucial part in our members' care and take that responsibility seriously. When faced with an obstacle, we are kind, respectful, and solution-oriented in our approach. We hold ourselves accountable to our clients and our members' success.
Rightway is a healthcare company looking to improve healthcare outcomes for everyone, everywhere. With that in mind, we have to consider what is good for the health of our team, the company, and the communities we operate in. As such, Rightway has determined a mandatory COVID-19 vaccination policy for all employees, in combination with other safety precautions, is the best way forward.
Rightway is PROUDLY an Equal Opportunity Employer that believes in strength in the diversity of thought processes, beliefs, background and education and fosters an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis covered by appropriate law. All employment is decided on the consideration of merit, qualifications, need and performance.
