Claims Resolution Specialist

Job Description

Job Description

Job Title : Claims Resolution Specialist (Andover, MA)

Overview :

The Claims Resolution Specialist performs a variety of professional duties in support of pharmacy services. This position is responsible for expediting payment from workers' compensation insurance carriers, monitoring electronic billing rejections, and maintaining accounts receivable. This is a phone-based position, CRS' will call the adjuster, get the payment and hunt it down (45 days). They will be expected to 25 claims per day once fully trained. Downtime and aged AR is monitored. 90% of the queue should be touched within 60 days and they look at cash flow that each CSR is bringing in. CSR's are aligned to regions, supporting their sales teams.

Responsibilities/ Job Duties :

• Review, investigate, and analyze claims to maximize recovery
• Monitor electronic billing rejections and take appropriate action
• Ensure proper filing of invoices and monitor billing statuses less than 60 days outstanding
• Develop and maintain internal systems for data collection and entry, financial analysis, and report generation; create and update spreadsheets and logs as necessary
• Serve as a liaison between insurance carriers, pharmacy benefit managers, patients, and internal company divisions
• Negotiate settlements with insurance carriers within their granted settlement authority level as needed
• Pursue subrogation and arrange for salvage to obtain maximum recovery

Minimum Education and Experience Requirements :

• 1+ years of experience working claim resolution
• Prior experience liaising between insurances, PBM's and patients
• Ability to meet performance metrics - 25 claims per day (once trained), touching 90% of queue within 60 days

Schedule/ Shift :

Monday - Friday

8am - 4:30pm or 8:30am - 5pm

Benefits :

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances)

• Health Benefits / Dental / Vision ( Medix Offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s).)

• 401k ( eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1)

• Short Term Disability Insurance

• Term Life Insurance Plan

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r\n\r\nOur commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?