Senior Claims Examiner

Senior Claims Examiner

Associate III - BPM

Who we are:

UST HealthProof is a dynamic company with a mission to lower the cost of care and deliver the future of healthcare. Our consumer-centric approach gives our health plan customers a modern infrastructure and reduced administrative costs, helping to drive better business results for our customers - and better outcomes for our communities.

We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States.

You Are:

UST HealthProof is looking for Senior Claims Examiner, reporting to the Claims Team Leader. The Senior Claims Examiner is responsible for the adjudication of healthcare claims utilizing specific policies and procedures. This role is responsible for reviewing data within the claims processing system, to determine if services rendered were appropriate and benefit coverage criteria were met. The Senior Claims Examiner is accountable for reviewing the adjudication system edits to determine whether to pay the claim and/or line item(s).

The Opportunity:

• Be responsible for processing assigned claims based on client-specified guidelines or as directed by the team leader.
• Be responsible for meeting productivity targets, financial and procedural accuracy standards as established by management.
• Mentor junior members of the team
• Collaborate with other team members on special projects as assigned by the team leads; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by the team leader.
• Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality.
• Participate in projects assigned by the team leader; these projects may include provider data, authorizations, enrollment, or other activities.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What you need:

• Solid understanding and ability to analyse claim data.
• ICD-10 CPT and HCPCS coding is a plus.
• Knowledge base of physician billing and hospital coding (ICD-10, HCPC, CPT-4), medical terminology, and authorization requirements
• High School degree required.
• 3 - 5 years healthcare claims processing experience
• Willingness to learn new skills.
• Team collaborator
• Strong work ethic
• The ability to adapt quickly to a fast-paced environment.
• A self-starter and quick learner
• Team player with an ability to collaborate.

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by applicable law, UST provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.

Role Location: Remote

Compensation Range: $39,520-$43,680

Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits.

What we believe:

We're proud to embrace the same values that have shaped UST HealthProof since the beginning. Since day one, we've been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone, to champion diversity and inclusion, and to place people at the center of everything we do.

Humility:

We will listen, learn, be empathetic and help selflessly in our interactions with everyone.

Humanity:

Through business, we will better the lives of those less fortunate than ourselves.

Integrity:

We honor our commitments and act with responsibility in all our relationships.

Equal Employment Opportunity Statement

UST HealthProof is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

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