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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare claims processing, including Medicaid and Medicare, while effectively advocating for members and resolving billing discrepancies. Proficient in analyzing claims and implementing solutions, with strong communication and mentoring abilities.
Highest-signal resume keywords
Healthcare Claims ProcessingMedicaid And Medicare ExperienceClaims Analysis And Problem-SolvingMS Word And Excel ProficiencyHIPAA Compliance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AnalysisBilling Discrepancy InvestigationCase ManagementProcess ImprovementDocumentation And Tracking
Soft Skills
Strong Listening SkillsAttention To DetailCritical ThinkingVerbal CommunicationWritten Communication
Tools & Technologies
Internal DatabasesDual-Monitor Workstation
Industry Keywords
ACA GuidelinesCOBRADental BenefitsVision BenefitsBehavioral Health Benefits
About the role
Key responsibilities & impact- Investigate billing discrepancies and identify claims errors
- Coordinate resolutions among members, carriers, and providers for timely claim processing
- Manage cases involving Medicaid, Medicare, motor vehicle claims, and other benefit programs
- Educate members about benefit plans and coverage details
- Adhere to internal policies, procedures, and federal regulations
- Collaborate with team members and escalate unresolved issues to supervisors or carriers
- Mentor new team members and share best practices
- Contribute to continuous process improvements
- Document and track cases using internal databases
- Advocate for members navigating healthcare claims and benefits
Requirements
What you’ll need- At least 2 years of experience in healthcare, customer service, or claims
- Experience analyzing claims, identifying root causes, and proposing practical solutions
- Strong listening skills and ability to guide members with care and patience
- Familiarity with plan documents, ACA guidelines, Medicare, COBRA, dental, vision, and behavioral health benefits is a plus
- Proficiency in MS Word and Excel
- Comfortable using internal databases to document and track cases
- Private, HIPAA-compliant workspace where confidential information cannot be viewed or overheard
- Sufficient desk space for a dual-monitor workstation and related equipment
- Reliable high-speed internet with minimum download speed of 200 Mbps
- Professional, distraction-free work environment during scheduled hours
- Ability to perform prolonged sitting, computer use, frequent phone use, fingering, grasping, pulling hand-over-hand, and repetitive motions
- Strong concentration, attention to detail, critical thinking, problem-solving, and verbal and written communication skills
Benefits
Comp & perks- Training and comprehensive support
- Opportunities for career growth and promotion from within
- Medical, dental, and vision coverage
- 401(k) with company match
- PTO
- Computer equipment, monitors, and other necessary technology provided
- Advanced systems and comprehensive training
- Collaborative team environment