Industry: Outsourcing/Offshoring
Job function: Health Care Provider
Seniority: Associate
Job Details:
Multinational professional services company Graveyard Shift Full-time Employment Voice-based operations Temporary WFH Setup for 2021 Competitive Salary Package HMO Coverage Remote/Virtual Recruitment Process
Responsibilities:
Claims management for Absence and Disability Insurance: Gathers info and performs variety of complex clerical or administrative support functions w/c require knowledge and understanding of disability policies and process to appropriately calculate the benefits due.
Manages incoming or outgoing telephone calls, emails, and/or faxes, including triage, opening of cases and data entry into client system. Determines contract; verifies eligibility and benefits. Adhere to federal and state regulatory and/or client plan requirements and established workflows. Obtains information from claimant or other supporting systems, emails and/or from fax. Manages claims, collection of non-clinical information needed for review from claimants and providers, utilizing scripts to screen basic and complex requests.
Qualifications:
Holds current and unrestricted local (PH) Registered Nurse license. Bachelor of Science Nursing (BSN) degree minimum of three (3) months of prior working experience as a Registered Nurse in a clinical setting required Three months is equivalent to 480 hours of working experience as an RN; Work experience as a Registered Nurse means holding an active RN license and providing direct patient care; Knowledge of disability claims management process and ability to interpret and apply member contracts, and member benefits; Knowledge of ICD-9 and ICD-10 and CPT codes, preferred;
The interview process will be remotely. This position is open to all PH Registered Nurse only.