Claims Specialist II

Elite Technical is seeking a Claims Analyst to support our Healthcare payor client in a remote setting for a 3 month+ duration contract. Duties required to support the claims unit is as follows:

- Accurate processing of claims edits, determining primacy for the Coordination of Benefits (COB), adjusting previously paid claims and initiating procedures to recover funds on overpaid claims. Analyzing, investigating, and resolving problem cases; executing recovery processes; and completing special projects.
- Identifying primary vs. secondary coverage when a member has more than one health plan
- Reviewing and updating claims to reflect correct COB rules
Applying COB primacy rules (subscriber status, effective dates, plan type, Medicare coordination, etc.)
- Communicating with members, providers, and other insurers to verify coverage details
- Correcting overpayments, initiating refunds or reprocessing, and maintaining accurate claim records
- Work...

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Submit your application today and join our talented team at EliteTechnical.