Claims Specialist

• Attend and complete the designated claims professional training program
• Adjust various levels of workers’ compensation claims under close supervision
• Process and respond to incoming mail, emails, and other claim-related documents
• Communicate with injured workers, insureds/employers, medical providers, attorneys, and carrier representatives through telephone, video conference, and email
• Investigate new and existing claims by gathering medical records, employer reports, and witness statements
• Investigate employer/employee relationships, policy verification, coverage, potential subrogation issues, and fraud indicators
• Determine coverage, compensability, and appropriate benefits according to jurisdictional guidelines and carrier program requirements
• Document claims files and code claim activity
• Prepare detailed reports documenting findings and recommendations
• Administer indemnity and medical benefits while maintaining calendared claim-related action items and state compliance
• Participate in virtual and/or in-person meetings, claim reviews, and business functions for training and claim discussions

IAP Claims Representative – SkillBridge Conversion

• Submit accurate and timely claims to third party payers
• Resolve claim edits and account errors before claim submission
• Follow up with third party payers to ensure collections and exceed department goals
• Gather statistics, complete reports, and perform scheduled or requested duties
• Organize and prioritize daily tasks for productivity, accountability, and efficiency
• Comply with Notices of Privacy Practices and HIPAA regulations concerning PHI and claim submission/follow-up
• Contact third party payers to resolve unpaid claims
• Use payer portals and websites to verify claim status and conduct account follow-up
• Assist Patient Access and Care Management with denial investigation and resolution
• Attend educational programs, department meetings, teleconferences, and webcasts as necessary
• Research and process returned mail and payer-rejected claims
• Reconcile billing account transactions and process billing and follow-up transactions accurately and timely
• Maintain knowledge of federal, state, and local hospital billing regulations
• Monitor accounts to facilitate timely follow-up and payment and maximize cash receipts
• Maintain work queue volumes and productivity within established guidelines
• Provide customer service to patients, visitors, and employees
• Work with supervisors and managers to develop and exceed annual goals
• Maintain confidentiality regarding demographic, clinical, and financial information
• Communicate workflow problems to management in a timely manner

Claims Specialist jobs in Virginia

IAP Claims Representative – SkillBridge Conversion

Insurance Claims Specialist