Job Description
Overview
BroadPath is hiring Healthcare Claims Examiners to work from home! As part of our remote team, you will play a key part in ensuring accurate and timely adjudication of claims for our contracted health plans.
If you're ready to be part of a dynamic team and enjoy the flexibility of working from home, we invite you to apply today!
Responsibilities
- Expertly process and resolve complex claims using advanced problem-solving skills
- Conduct comprehensive claim audits for both hardcopy and electronic submissions
- Resolve intricate provider and member eligibility challenges
- Generate emergency reports and authorizations with precision
- Execute third-party liability and coordination of benefit claim assessments
- Proactively identify and report potential system improvements
- Serve as a technical resource and trainer for claims processing team
- Navigate complex plan contracts and pricing structures
- Interpret benefit plans and routing claims for specialized services
- Collaborate cross-functionally with Customer and Provider Services teams
- Expert analytical skills with exceptional attention to detail
Qualifications
- Ability to communicate well with supervisors and co-workers
- Ability to analyze claim issues and “trouble shoot” claims problems
- Ability to work in a high volume, production-oriented environment
- Detail oriented with an ability to sit for extended period of time
- Ability to work under demanding performance standards for production and quality
- Technical competence with claims processing software
- Ability to understand and implement complex claims procedures
- Medical terminology
- Knowledge of DOFR, HEDIS, DOC, HCFA and NCQA requirements
- Aware of AS400 systems and/or experience with manually processing claims
- Ability to act as a resource and /or trainer for claims processors
EDUCATION: High school diploma or equivalent required
EXPERIENCE:
- 3 years of experience processing regular and complex claims
- Knowledge of ICD-9, CPT, HCPC, and Revenue Coding required
Diversity Statement
At BroadPath, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation!
Equal Employment Opportunity/Disability/Veterans
If you need accommodation due to a disability, please email us at HR@Broadpath.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application process
BroadPath is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law
