Columbia, SC, US
Contract to Hire
Overall Purpose of Position:
- Responsible for responding to routine inquiries from members in health care claims.
- Review and adjudicate claims and/or non-medical appeals.
- Determine whether to return, deny or pay claims following organizational processes and procedures.
Responsibilities of Job:
- Responds to written and/or telephone inquires according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity and quality are met.
- Accurately document inquiries in computer system
- Identifies incorrectly processed claims and process adjustments and reprocessing actions according to department guidelines. (40%)
- Examines and process claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Ensures claims are processing according to established quality and production standards. (40%)
- Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution. Identifies and promptly reports and/or refers suspected fraudulent activities and systems errors to the appropriate departments. (20%)
Must be able to pass a drug test, background check, 7 year employment verification and have at HS diploma or GED. Associates degree is preferred.
Our people are everything. As a Best of Staffing® Client and Talent leader, Aerotek® Inc. has distinguished itself as a leader in recruiting and staffing services, by having a deep understanding of the intersection of talent and business. As a strategic partner to more than 17,000 clients and 300,000 contract employees every year, Aerotek's people-focused approach yields competitive advantages for its clients and rewarding careers for its contract employees. Headquartered in Hanover, Md., Aerotek operates a network of over 230 non-franchised offices with more than 6,000 internal employees dedicated to serving our customers. Aerotek is an operating company of Allegis Group, a global talent solutions provider. To learn more, visit aerotek.com.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email firstname.lastname@example.org for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.