Claims Specialist Job at NuWest Group, Renton, WA

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  • NuWest Group
  • Renton, WA

Job Description

Claims Specialist

M-F - 8-5

$25-30/hr

In office in Renton. once trained hybrid may be available. This is NOT a remote role.

Description

Adjudicates claims submitted by outside purchased services for PMC's enrolled capitated population and communicates those actions. Adjusts complex claims for advanced processing needs. Responds to Customer Service Requests and resolves problem claim situations.

Providence caregivers are not simply valued – they’re invaluable.

Required Qualifications:

  • H.S. Diploma or GED or equivalent experience in Health Care Business Administration.
  • 2 years in Managed Care operations.
  • 1 year of Claims processing experience , in a TPA, MSO, HMO, PHO or large group practice setting.
  • Experience with areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health and Encounters).
  • Information systems supporting the administration of managed care products.

Preferred Qualifications:

  • IDX healthcare software application.
  • CHAMPUS, Medicare and/or Medicaid benefits/programs.

Job Tags

Work at office,

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