Claim Adjudication jobs

Role description

Senior Claims Examiner (Claims Examiner- III)
About UST HealthProof
At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for members. UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth. UST HealthProof is looking for Senior Claims Examiner, reporting to the Claims Team Leader. The Senior Claims Examiner is responsible for the adjudication of healthcare claims utilizing specific policies and procedures. This role is responsible for reviewing data within the claims processing system, to determine if services rendered were appropriate and benefit coverage criteria were met. The Senior Claims Examiner is accountable for reviewing the adjudication system edits to determine whether to pay the claim and/or line item(s).
As a Senior Claims Examiner at UST HealthProof, this is your opportunity to Be responsible for processing assigned claims based on client-specified guidelines or as directed by the team leader
Be responsible for meeting productivity targets, financial and procedural accuracy standards as established by management
Mentor junior members of the team
Collaborate with other team members on special projects as assigned by the team leads; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by the team leader
Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality
Participate in projects assigned by the team leader; these projects may include provider data, authorizations, enrollment, or other activities
Perform other duties as assigned
You bring:
High School degree required
3 - 5 years healthcare claims processing experience
Solid understanding and ability to analyse claim data
ICD-10 CPT and HCPCS coding is a plus
Knowledge base of physician billing and hospital coding (ICD-10, HCPC, CPT-4), medical terminology, and authorization requirements
Willingness to learn new skills
Team collaborator
Strong work ethic
For this role, we value:
The ability to adapt quickly to a fast-paced environment
A self-starter and quick learner
Team player with an ability to collaborate

Skills

claims adjudication,healthcare claims,claims processing,hcpcs coding,medical terminology,health insurance,policy procedures,

About UST
UST is a global digital transformation solutions provider. For more than 20 years, UST has worked side by side with the world’s best companies to make a real impact through transformation. Powered by technology, inspired by people and led by purpose, UST partners with their clients from design to operation. With deep domain expertise and a future-proof philosophy, UST embeds innovation and agility into their clients’ organizations. With over 30,000 employees in 30 countries, UST builds for boundless impact—touching billions of lives in the process.