SPE-Claims HC
This office-based, night shift role is for a Claims Specialist focused on commercial claims adjudication and pre-adjudication processes in the healthcare industry. You will analyze and process commercial claims with precision to ensure compliance with company policies and industry standards, collaborate with cross-functional teams to streamline pre-adjudication workflows, and identify discrepancies to implement corrective actions. The role involves maintaining current knowledge of healthcare regulations, providing detailed reports on claims trends for strategic decision-making, and engaging in continuous improvement initiatives to optimize processing workflows. You will also support the development and implementation of new claims processing technologies and contribute to creating policies and procedures that enhance efficiency. Strong analytical skills and excellent written and spoken English communication are essential.
