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Claims Processor IV
Sentara Health. Handle all areas of customer service related to acquisition and/or retention of Sentara Health Plan members .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in customer service, health plan claims disbursements, and administrative processes, with a strong focus on member interaction and report preparation. Holds relevant certifications and possesses the ability to work effectively in a remote environment.
Highest-signal resume keywords
CPC CertificationHealth Plan Claims DisbursementsCustomer Service ExperienceAdministrative ExperienceReport Preparation
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 ProcessingData AnalysisReport PreparationCustomer InteractionAdministrative Support
Soft Skills
CommunicationProblem-SolvingTeam Collaboration
Tools & Technologies
New Technology Testing
Certifications & Qualifications
CPC CertificationRelated Medical CertificationAssociates Degree
Industry Keywords
Health PlanMember AcquisitionMember RetentionProvider InteractionRemote Work
About the role
Key responsibilities & impact- Handle all areas of customer service related to acquisition and/or retention of Sentara Health Plan members
- Administer group information
- Process claims
- Interact with members, providers, and employers
- Complete initial review and analysis for special reports and projects
- Provide recommendations and SBARs when assigned
- Prepare Research Team monthly/quarterly reports when assigned
- Participate in provider site visits and conference calls when assigned
- Test new technology as assigned
Requirements
What you’ll need- High School Grad or Equivalent REQUIRED
- CPC certification OR Related Medical Certification OR Associates Degree (or higher) REQUIRED
- 3 years of Administrative experience REQUIRED
- 3 years Customer Service REQUIRED
- 3 years Health Plan Claims Disbursements REQUIRED
- Candidates must work remotely from an eligible state: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, West Virginia, Wisconsin, or Wyoming
- Availability for 8am to 5pm EST, Monday through Friday; multiple shifts available
Benefits
Comp & perks- Medical, Dental, Vision plans
- Adoption, Fertility and Surrogacy Reimbursement up to $10,000
- Paid Time Off and Sick Leave
- Paid Parental & Family Caregiver Leave
- Emergency Backup Care
- Long-Term, Short-Term Disability, and Critical Illness plans
- Life Insurance
- 401k/403B with Employer Match
- Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
- Student Debt Pay Down – $10,000
- Pet Insurance
- Legal Resources Plan
- Opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met
- Shift differentials, standby/on-call pay, overtime, shift premiums, extra-shift incentives, or bonus opportunities may be available
- Remote work arrangement