Correct Care Solutions Self-funded Group Insurance Claims Processor in Hendersonville, Tennessee
Our Self-funded Group Insurance Claims Processor will review and adjudicate medical, vision, dental, and short-term disability health claims and assist members with all claim related questions including verification of benefits.
- Must have high school diploma or GED
Two (2) years of medical claim processing experience with an insurance company or Third party Administrator.
Completes accurate analysis of claim determination for payment or denial based on established rules and processes.
Monitor claim inventory of assigned accounts and ensure turnaround and productivity benchmarks are met.
Processes claims from returned pended claims reports and those containing claim edits.
Manually prices claims based on specific rates.
Audit peer’s work for continued cross training and education.
Follow-up on provider calls on status, explanation of payment, billing errors, and refund requests.
Communicate to Claims Leadership any issues that would impede the accurate and timely processing of claims.
Must be able to apply principles of critical thinking to a variety of practical and emergent situations and accurately follow standardized procedures that may call for deviations.
Must be able to apply sound judgment beyond a specific set of instructions and apply knowledge to different factual situations.
Must be alert at all times; pay close attention to details.
Must be able to work under stress on a regular or continuous basis.
Perform other duties as assigned.
CCS is an EOE/Minorities/Females/Vet/Disability Employer
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Location TN, Hendersonville
Facility Health Cost Solutions
Type Regular Full-Time