Claims Specialist

PartneredStaffing-KellyServices

Lake Mary, FL, United States contract

Posted: October 28, 2016

Job Description

At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.

Kelly Services is currently seeking several Claims Specialist for our client's Lake Mary, FL location.

In addition to working with the world’s most recognized and trusted name in staffing, Kelly employees can expect:
Competitive pay
Paid holidays
Year-end bonus program
Recognition and incentive programs
Access to continuing education via the Kelly Learning Center

Pay $15 - $16 per hour
Schedule: Monday through Friday - 9:00am - 6:00pm
Duration: 4 months possible extension (Possible temp - perm)
Anticipated start date: 10/31/2016 to 03/31/2017

SUMMARY
Responsible for various reimbursement functions, including but not limited to accurate and timely claim submission, claim status, collection activity, appeals, payment posting, and/or refunds, until accounts receivable issues are properly resolved.

MAJOR JOB DUTIES AND RESPONSIBILITIES

Verify member submitted claims forms, member’s eligibility and pharmacy information is complete and accurate, updating system information as needed.
Superior data entry proficiency is expected in order to provide accurate and timely processing of claims submitted by member, pharmacy or appropriate agency.
Moderate knowledge of drugs and drug terminology used daily.
Process claims according to client specific guidelines while identifying claims requiring exception handling.
Navigate daily through several platforms to research and accurately finalize claim submissions.
Oral or written communication with internal departments, members, pharmacies or agencies to resolve claim issues.
Adhere to strict HIPAA regulations especially when communicating to others outside
Prioritize and coordinate influx of daily workload for claims processing, returned mail and out-going correspondence and e-mails to assure required turnaround time is met.
Assess accuracy of system adjudication and alert management of potential problems affecting the integrity of claim processing.
Analyze claims for potential fraud by member or pharmacy.
May be required to work on special projects for claims team.
EDUCATION/EXPERIENCE

High School Diploma or GED Required
1-3 years of Call Center and Reimbursement experience required
Knowledge of completed benefits verifications, submitted test claims, completed or reviewed prior authorizations required
Strong data entry and 10-key skills
Proficient in MS Word and Excel

Why Kelly?

As a Kelly Services candidate you will have access to numerous perks, including:

Exposure to a variety of career opportunities as a result of our expansive network of client companies

Career guides, information and tools to help you successfully position yourself throughout every stage of your career

Access to more than 3,000 online training courses through our Kelly Learning Center

Group-rate insurance options available immediately upon hire*

Weekly pay and service bonus plans

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