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Claims Appeals Processor
$45k-57k (estimate)
Full Time | Business Services
3 Weeks Ago
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Group Health Cooperative of Eau Claire is Hiring a Claims Appeals Processor Near Altoona, WI
Position Purpose
To investigate and process appeals claims in an accurate, timely and efficient manner.
Essential Position Functions
To investigate and process appeals claims in an accurate, timely and efficient manner.
Essential Position Functions
- Investigate provider appeals and provide recommendations to the Claims Team Leads and Compliance Appeals Specialists within the required timelines.
- Work in close conjunction with Compliance, Health Management and the Claims department to determine the accuracy of claims processing on appealed claims and identify opportunities for process improvement and/or provider education.
- Re-process appealed claims when necessary, assuring the claims are adjudicated in accordance with the determinations made during the Appeals process.
- Answer claims questions from other departments as needed.
- Identify and communicate system issues, billing patterns, training opportunities, etc. to the Claims Supervisor as needed.
- Comply with all policies and procedures of KMTSJ, Inc.
Minimum Requirements of the Position
- One to two years prior claims processing experience.
- High level of proficiency in Microsoft Excel and Word.
- Excellent communication skills and ability to work independently and in a team environment..
This full time position offers an outstanding benefit package, including three weeks of vacation the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: resumes@group-health.com. Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.
Group Health Cooperative of Eau Claire considers candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
Group Health Cooperative of Eau Claire considers candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
Job Summary
JOB TYPE
Full Time
INDUSTRY
Business Services
SALARY
$45k-57k (estimate)
POST DATE
04/11/2024
EXPIRATION DATE
04/28/2024
WEBSITE
group-health.com
HEADQUARTERS
ALTOONA, WI
SIZE
25 - 50
FOUNDED
1976
CEO
CLAIRE JOHNSON
REVENUE
<$5M
INDUSTRY
Business Services
Related Companies
About Group Health Cooperative of Eau Claire
Group Health Cooperative is a community-based non-profit health plan that delivers high-quality, personalized service to its members. The Cooperative started as a local coalition over 30 years ago. While it is still a local plan with a local focus, it is now a nationally recognized HMO serving over 70,000 members in Western Wisconsin.
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