Job Summary

The TL-Claims HC role is pivotal in managing and overseeing claims adjudication processes within the healthcare sector. This position requires a deep understanding of claims and payer domains with a focus on utilizing MS Excel for data analysis and reporting. The candidate will work from home during night shifts ensuring efficient and accurate claims processing to enhance organizational performance.

Responsibilities

Lead the claims adjudication team to ensure timely and accurate processing of healthcare claims.
Oversee the implementation of best practices in claims management to improve efficiency and reduce errors.
Provide expert guidance on complex claims issues leveraging domain knowledge in claims and payer processes.
Utilize MS Excel to analyze claims data identify trends and generate insightful reports for decision-making.
Collaborate with cross-functional teams to streamline claims workflows and enhance operational effectiveness.
Monitor compliance with regulatory requirements and internal policies to maintain high standards of claims processing.
Develop and maintain documentation of claims procedures and policies for training and reference purposes.
Facilitate regular training sessions for team members to keep them updated on industry changes and new technologies.
Drive continuous improvement initiatives to optimize claims adjudication processes and enhance customer satisfaction.
Ensure effective communication with stakeholders to address queries and resolve issues promptly.
Implement strategies to minimize claim denials and maximize reimbursement for healthcare services.
Coordinate with IT teams to integrate advanced tools and technologies for claims management.
Support the organizations mission by contributing to the efficient handling of claims ultimately benefiting patients and healthcare providers. Qualifications
Demonstrate proficiency in MS Excel for data analysis and reporting.
Exhibit strong knowledge of claims adjudication processes and payer domain expertise.
Possess excellent problem-solving skills to address complex claims issues.
Show ability to work independently and manage tasks effectively during night shifts.
Display strong communication skills to liaise with stakeholders and team members.
Have experience in developing and implementing claims management strategies.
Demonstrate commitment to maintaining compliance with industry regulations and standards.

Certifications Required

Certified Professional in Healthcare Quality (CPHQ) Advanced Excel Certification

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TL-Claims HC