Industry: Outsourcing/Offshoring 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
Job function: Health Care Provider
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.
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.