KyanosAi Career

*Join Our Product Client*

We are Hiring for Claim Specialist to join our healthcare client. As a Claim Specialist, you will play a critical role in ensuring accurate and efficient claims processing.

*Job Summary:*

– Review and process medical insurance claims
– Investigate and resolve claim discrepancies
– Communicate with healthcare providers and internal stakeholders
– Apply knowledge of medical terminology and insurance policies

*Requirements:*

Job Summary

As a Claims Specialist you will complete claim processing tasks and duties while performing best practices in time management, inventory, quality and procedures.

Essential Functions/Responsibilities/Duties

• Maintain quality and procedure standards including compete review and examination of claim to ensure proper handling in accordance with company policies and procedures.
• Complete claims task in timely manner and maintain production requirement:
• Review and understand plans, documents and vendors. Ensure proper system setup while processing claims. Identify and report to management any potential errors, problems or issues regarding plan documents, claims processing or system setup.
• Work stop loss renewal process, as directed by management.
• Complete all training requirements in a timely manner, as directed by management.
• Understand and enforce company procedures, polices and standards.
• Practice good follow up procedures to ensure completion of task and/or inquiries.
• Direct client contact, internal staff and vendor support to ensure customer and member satisfaction.
• Support management team with projects and special requests.

Education and Experience

• High School Diploma required
• Associate’s degree in business preferred
• 2+ years claims processing