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Claims Processor

Remote • Posted 12 days ago • Updated 12 days ago

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Travel Required

Remote

Depends on Experience

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K-Tek Resourcing LLC

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Job Details

Skills

Auditing
Health Care
Claims
Claims Processing
Medical Claims
Claims Associate
Claims Examiner
Reporting
Pharmacy

Summary

ROLE: Each associate is responsible for validating members Out-of-Pocket Maximum (OOPM) cost shares based on the audit years provided in the Accumulator Overages Report. The process involves reviewing the members responsibilities according to their plan benefits and ensuring that OOPM limits and any overages are accurate, following the preset criteria established by Centene. If a member has exceeded their OOPM limit, the excess amount will be reimbursed directly through medical claims and pharmacy reimbursements.

1-3 Years of experience in claims processing
Good logical thinking ability
Knowledge of US Healthcare Industry
Should have exposure to MS Office

RESPONSIBILITY:

Adjudication/Adjustments of claims with zero errors
Completion of claims in queue within specified time fram

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 10411276
Position Id: 8823036
Posted 12 days ago

Company Info

About K-Tek Resourcing LLC

Vision

To be a trusted partner and advisor to our customers

Mission

At K-Tek we believe in understanding the specific needs of the customer and tailor-creating innovative solutions to meet these needs. We invest in our employees and customers. We build a relation of trust with our customers through empathy, solutions and being the first time right.

Who We Are & What We Do

K-Tek Resourcing is a consulting organization with offices in Houston TX and St. Paul, MN. It is supported by 2 global delivery centers, located in India. With its global employee strength of over 250, K-Tek has been supporting its clients for over 9 years. We have been consistently achieving a growth of 30% Year on Year. We have an extensive experience of working in domains including BFSI, Retail, Healthcare and Pharma, Oil & Gas, Travel & Hospitality and Insurance. The technologies we service are IT Infrastructure, Mobile Technologies, Cloud & Big Data Solutions. We understand the needs of our customers and provide them with customized solutions and resources with the tenet of being the "First Time Right".

Values

-Commitment to our customers success through Integrity

-Excellence through Quality

-Growth through customer value creation

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Claims Processor - K-Tek Resourcing LLC - Remote | Dice.com

Claims Processor

K-Tek Resourcing LLC

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Job Details

Skills

Summary

Company Info

About K-Tek Resourcing LLC

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