Claims Specialist

Job Description:

Overview

Advanced Hearing Providers (“AHP”) coordinates hearing healthcare services for employees with workers’ compensation claims. We connect patients with our nationwide network of qualified hearing healthcare providers on behalf of our clients; the payers and third-party administrators of workers’ compensation claims.
We are seeking hard-working, self-motivated candidates with a positive attitude who like the idea of being involved in the process of helping people hear better. The position of Claims Specialist (“CS”) plays a critical role in the operation of the organization. The main function of an AHP CS is coordinating authorized hearing healthcare for covered employees.
AHP staff work as a TEAM – this is crucial! We expect team members to build trust and respect for each other by producing consistent results and going above and beyond, especially to help each other. Even though each CS will be working on their own assigned cases, interaction with other team members, clients, providers, and patients will occur often.
 
Pay Range - $18-$18.75/hr plus monthly incentive

Responsibilities

- Obtain a complete, thorough understanding of the workers’ compensation claims administration process, fees and participants.
- Adhere to customer Service Level Agreements (SLAs) by maintaining contact with clients, providers, and claimants/patients as prescribed to ensure all parties are kept informed of the process status.
- Successfully prioritize the workday utilizing our task-based systems, resulting in achieving daily completion of all required tasks (ensuring SLA compliance).
- Ensure claim files are properly documented.
- Demonstrate an understanding of the workers’ compensation referral and RFA process
- Demonstrate an understanding of navigating client/claimant requirements to ensure billable item eligibility is reviewed prior to submitting requests to client
- Perform verification of all HCPC/CPT codes that will be requested. This includes not only verifying eligibility but confirming whether NCCI edits and/or a state fee schedule (SFS), is applicable.
- Coordinate the completion of necessary documentation to be filed with state agencies when applicable.
- Maintain a high degree of detail and accuracy throughout the claim administration process.
- Other duties as assigned by the manager

Qualifications

- Advanced knowledge and experience with computer systems and business software programs, in particular Salesforce, Word, Excel, Outlook, Office 365 Apps and Adobe Acrobat
- Previous workers’ compensation, insurance claims management, and/or hearing healthcare industry experience is preferred
- Bilingual skills will be extremely helpful with some patients
- Excellent grammar and written skills
- Ability to type at a minimum of 40 WPM
- Ability to travel for training and occasional on-site meetings
This role works remotely. You will need the following when working from home:
- Reliable and secure Internet Service Provider at home (no public WiFi) for duration of working hours
- Sufficient room to set up a laptop, monitors, keyboard and mouse
- Comfortable space to work for duration of working hours
- Quiet, private and secure space in which to work
 Other Personal Characteristics and Experience
- Communicate clearly, professionally and in a timely manner.
- Manage multiple tasks simultaneously in a proficient manner.
- Ability to maintain professional client and provider relationships.
- Work collaboratively with colleagues, including regularly providing direct support by completing team members’ tasks for them as needed.
- Understand when situational discretion must be employed in the handling and sharing of client, provider, and/or claimant information.
- Self-motivated; ability to work independently
- Must have a high attention to detail
- Must be coachable and receptive to feedback
- Must be dependable and consistent
- Ability to take a proactive approach to all situations
- Driven by a focus on reaching a specific objective or accomplishing a given task
- Eagerness to adapt to new methods
- Obtain satisfaction from delivering great customer service
- Willing to try new things/operate outside of your comfort zone
EDUCATION
- HS Diploma or equivalent
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