Novi, MI, 48376, USA
1 day ago
Medical Claims Representative
Description We are in search of a Medical Claims Representative to join our team in NOVI, Michigan. This role is pivotal in the healthcare industry, providing a crucial bridge between patients, healthcare providers and insurance companies. You will have the chance to work in a dynamic environment and contribute to ensuring a smooth and efficient process for medical claims. Responsibilities: • Initiate and manage claims from clients, ensuring all necessary documentation is received and properly processed. • Assign electronic disability claim notifications to the appropriate supervisors or DNCMs following client-specific protocols. • Conduct member outreach regarding the disability claim review process in line with approved scripts. • Keep track of incoming claim documents to ensure timely receipt and processing. • Prepare and dispatch claim correspondence documents to members within established timeframes. • Utilize various software (Microsoft Office, Excel, Microsoft CRM, Oracle, etc.) to create or modify documents such as reports, memos, and letters. • Answer incoming telephone calls regarding claims and forward to the appropriate staff member when needed. • Compile and verify all claim documents to create Recommendation Summaries to be sent to the client upon completion of the disability claim review process. • Sort and distribute incoming correspondence including mail, faxes, email and/or UPS/FedEx. • Assist in tracking and trending department turnaround times for reporting purposes. • Maintain strict confidentiality regarding client, staff, and organizational information. • Perform general clerical duties including copying, scanning, faxing, mailing, and filing as necessary. • Upload documents into Spring CM and SharePoint as applicable. Skills: • Proficiency in Allscripts, Cerner Technologies, EHR SYSTEM, Epic Clinical, Epic Software. • Experience in Appeals, Benefit Functions, Billing Functions, Claim Administration, Collection Processes. Requirements • Proficiency in Allscripts, Cerner Technologies, EHR SYSTEM, Epic Clinical, and Epic Software • Experience with appeals, benefit functions, and billing functions • Knowledge of claim administration and collection processes • Strong interpersonal and communication skills • Ability to work independently and within a team • Detail-oriented with strong organizational skills • Excellent problem-solving abilities • Ability to maintain confidentiality and adhere to ethical standards • Familiarity with medical terminology and healthcare regulations • Proficiency in Microsoft Office Suite, including Word, Excel, and Outlook • Strong customer service skills and ability to manage patient inquiries effectively • Ability to multitask and prioritize tasks efficiently • Willingness to keep up-to-date with industry changes and advancements • Strong written and verbal communication skills • Ability to work in a fast-paced, high-pressure environment. Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information. © 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .
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