Claims Representative - Evernorth - Remote
POSITION SUMMARYThis position entails processing of direct member and pharmacy submitted claims timely and accurately. Validate member’s eligibility and ensure claim information entered is complete and accurate. Process claims according to client specific guidelines while identifying claims requiring exception handling. Analyze claims for potential fraud by member or pharmacy. Research to define values for missing information not submitted with claim but required for processing. Utilize internal systems, resources and/or making out bound calls to pharmacies for missing information.Initiate correspondence to members, pharmacies or other internal departments for claim denials, missing information, or other claim issues. Navigate daily through multiple platforms to research and accurately finalize claim submissions. Adhere to strict HIPAA regulations especially when communicating to others outside of Express Scripts. Miscellaneous duties/projects as assigned. The candidate must reside in one of the following counties in Illinois or Missouri-• Illinois: Bond, Calhoun, Clinton, Jersey, Madison, Monroe, St.Clair. • Missouri: Franklin, Jefferson, Lincoln, St. Charles, St. Louis County, St. Louis City, WarrenKey Qualifications• High school diploma or GED required• 2+ years medical and/or pharmacy claims processing experience• Demonstrated 10 key data entry skills• General PC Knowledge: MS Office, Internet, some experience with Excel, PowerPoint, and WebEx preferred• Excellent communication (oral and written) skills• Ability to work a flexible schedule• Strong attention to detail, accuracy and quality to meet goals• Ability to work in a fast-paced environment, making independent decisions• Advanced problem-solving skills:• Ability to diagnose a situation and make recommendations on how to resolveIf you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an hourly rate of 17.75 - 25 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs.We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at bolthires Group. AboutThe bolthires GroupDoing something meaningful starts with a simple decision, a commitment to changing lives. AtThe bolthires Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions bolthires Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients.Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response. The bolthires Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment.These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances. Apply tot his job