Claims Processor - Fully Remote

Job Details

Who We Are:

Nonstop Administration and Insurance Services, Inc. is a fast-growing health insurance organization with a firm belief that everyone should have access to high-quality, affordable healthcare. To achieve this goal, we offer an employer-sponsored group health insurance solution called Nonstop Health

What Nonstop is Looking For:

We are looking for a candidate with a minimum of 2 years of experience in processing health insurance claims. The Claims Processor role entails efficiently using resources to accurately and promptly handle simple to moderately complex medical claims. This involves adhering to company policies, procedures, and guidelines, operating within a Mac environment, utilizing Google Suite (or similar tools), and demonstrating intuitive problem-solving skills. If you have claims experience in the health insurance industry and would like to work in the comfort of your own home this may be the perfect role for you!

Duties & Responsibilities:

• Enter claims data into the system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures.
• Review, analyze, and resolve claims through the utilization of available resources for moderately complex claims.
• Analyze and apply plan concepts to claims that include; deductible, coinsurance, copay, out of pocket, etc.
• Examine claims to determine if further investigation is needed from other departments and route claims appropriately through the system.
• Release claims by the deadline to meet company, and state regulations, contractual agreements, and group performance guarantee standards.
• Perform all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
• Resolve medical claims by approving or denying documentation, calculating benefits due, initiating a payment, or composing a denial response
• Communicate extensively with members and carriers regarding adjustments to resolve errors/issues, using clear, simple language to ensure understanding
• Complete daily, all documentation in the system and communicate the status of tickets as needed, adhering to all reporting requirements
• Demonstrate positive relationship skills with all telephone/email encounters
• Other duties as assigned by the dept manager.

Requirements

Required Skills, Experience, and Education:

• A high school diploma or GED equivalent required
• Experience processing or an in-depth understanding of health insurance/medical claims required
• Customer service experience
• Exceptional ability to build trust and communicate with members in order to fully meet their needs
• Ability to navigate various computer applications
• Strong ability to maintain a high level of accuracy and proficiency in all aspects of account maintenance
• Highly motivated with the ability to work as a team player and as an individual contributor
• Ability to be organized and work efficiently through your workday.
• Ability to protect operations by keeping claims information confidential by following HIPAA regulations
• Review emails within 24 hours, tickets within 7-10 business days, and client voicemails within 2 to 4 hours.
• Experience with Wex or comparable claims processing technology preferred
• Confident critical thinker with intuitive problem-solving abilities
• Proficient with Google Suite products (Sheets, Docs, etc.) or equivalents
• Ability to maintain confidential and meticulous records
• Ability to understand and commit to deadlines
• Ability to confidently request assistance and direction
• Ability to relate to and communicate with staff, management, and clients effectively and professionally

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer per day
• Repetitive use of fingers, hands, elbows, and arms including typing, reaching, grasping, and writing
• Ability to lift, carry, push, pull, and carry 5-30 pounds occasionally
• Hearing and speaking ability sufficient to carry on a conversation with another individual (or groups of individuals) in person and over the telephone.
• Visual ability is sufficient to read and produce printed material and information displayed on a computer screen.

Compensation and Perks:

• Full-time / Non-exempt / Hourly Position
• $28.85 per hour
• Fully Remote position
• Monday - Friday / No Weekends!
• Education Reimbursement
• 401(k) plan participation with employer-matched contributions
• Full medical, dental, and vision benefits with 100% employer-paid premiums
• Voluntary Benefits offered for employees and dependents

Nonstop provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Salary Description

$28.85 per hour

 Nonstop Administration and Insurance Services

 07/02/2024

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