Associate Business Process Services-Mailroom & Claims Team, Nevada / Remote

Summary

As Associate Business Process Services-Mailroom & Claims Team, Nevada / Remote, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Your role in our mission

• Adjudicate, research, and review complex claims and appeals
• Analyze trends and generate reports on claims and appeals activity
• Investigate and respond to claim appeals with well-supported decisions
• Represent and support appeal determinations in hearings and preparation meetings
• Ensure HIPAA compliance, maintain confidentiality, and provide team support as needed

What we're looking for

• Strong verbal/written communication and literacy
• Knowledge of Microsoft products (Outlook, Word, Excel and TEAMS)
• Demonstrated ability to analyze information and think strategically
• High proficiency, with exceptional level of accuracy required
• Proven ability to work independently and as part of team
• Claims processing or other experience in healthcare, health insurance or Medicaid is preferred.

What you should expect in this role

• Fully remote role
• Standard schedule: Monday–Friday, 8 hours per day
• Flexible start times between 7:00–8:00 AM based on workload
• Occasional overtime may be required, though infrequent
• Limited travel may be needed to attend and represent at Fair Hearings