Job Description
About us:
Lumen Solutions Group Inc., a dynamic small and minority-owned, Disadvantaged Business Enterprise headquartered in Florida, USA. As a leading consulting services and solutions provider, we focus on IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation for our clients. Our client base includes Fortune 500, Government, non-profit and emerging growth companies.
Job Description: ** FULL TIME REMOTE***
PURPOSE:
Investigate and perform adjustment of claims and ensure that claims are handled properly within authority limits, and in line with standard procedures and guidelines. Verifies insurance claims by reviewing claims requirements; examining documentation and calculations; highlighting and summarizing out-of-line situations; recommending changes in operating processes; completing reports, logs, and audit records.
ESSENTIAL FUNCTIONS:
60% Proactively investigate and perform adjustments of claims. Ensure claims are handled within authority limits, and in line with standard procedures and guidelines.
20% Updates claims audit records by entering, verifying, and securing data.
10% Settle standard/complex claims through payment or denial.
5% Provides claims audit information and reports by collecting, analyzing, and summarizing data and trends.
5% Improves claims adjustment job knowledge by attending training sessions
Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education Level: High School Diploma or GED
Experience: 5+ years claims experience and complete understanding of all systems, policies and procedures.
Preferred Qualifications Knowledge, Skills and Abilities (KSAs)
Experience with Inter-Plan Teleprocessing System (ITS) Claims.
Ability to analyze information gathered from investigation, Proficient
Excellent communication skills both written and verbal., Proficient
Ability to recognize, analyze, and solve a variety of problems., Proficient
Skill in completing assignments accurately with attention to detail., Proficient
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
***Lumen and / or its clients will not provide equipment (Laptop, monitor, etc.) to the selected contractor. The contractor must have their own equipment. Access to a virtual desktop set up (software) will be provided by Lumen’s client, allowing the user access to the required systems and technology. ***
Lumen Solutions Group Inc. is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.
Job Tags
Full time, For contractors, Immediate start, Remote job,