Evry Health is seeking a Claims Specialist to support the end-to-end claims adjudication process for a health insurance plan. This role is responsible for reviewing claim forms, testing claim configuration and benefit setup, verifying eligibility and coordination of benefits, and finalizing claim determinations based on plan benefits.
The position also includes auditing auto-adjudicated claims for accuracy, ensuring claims are processed in accordance with state and federal regulations, and maintaining desktop procedures related to claim adjudication. The role reports to the Vice President of Operations with oversight from the Claims Team Leader.
Required experience and skills
- Minimum of 3 years of medical claim adjudication or examination experience
- Experience working within a health insurance carrier, health insurance TPA, or equivalent
- Knowledge of medical and insurance terminology, including CPT, ICD-10, HCPCS, and revenue codes
- Strong attention to detail, problem-solving skills, and a high level of accuracy
- Experience writing desktop procedures
- Strong verbal and written communication skills
- Ability to work in a fast-paced, deadline-oriented environment
- Proficiency with Microsoft Office applications such as Word, Excel, Outlook, and OneNote
- Prior experience using a CRM, preferably Salesforce
- Prior experience with claim testing and/or auditing
- Ability to collaborate with Customer Service, Medical Management, and Appeals/Grievance teams
- Certified Coding Specialist (CCS) or Certified Coding Professional (CPC) preferred
- Plexis or Quantum Choice experience is a plus
Benefits
- Competitive salary
- Comprehensive health, dental, and vision insurance
- Life and disability coverage
- Retirement savings plan with company match
- Generous time off/vacation
- Professional development opportunities
- Flexible work environment
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$55,000 - $60,000
Remote work allowed
Yes
Posted
1 week ago