Job Title: Claims Coordinator

Department: Claims

Reports To: Claims Supervisor

CSTS (supporting Ultimate Health Plans) is seeking a dedicated and detail-oriented Claims Coordinator to support the daily administrative functions, communications, and correspondence of our claims department. The ideal candidate will work with internal and external departments and providers on claims-related content, ensuring timely and accurate processing of all claims.

Remote position but Florida-based candidates heavily preferred.

Essential Duties and Responsibilities:

Collaborate with internal and external departments and providers on claims-related matters.
Provide timely follow-up on provider callbacks.
Perform data entry for paper claims for all D-SNP members and batch non-D-SNP paper claims for the appropriate team.
File important emails in appropriate e-files within Outlook and report claims escalations to the Claims Operations Supervisor.
Assist with responding to customer service/MAT team inquiries via call routes.
E-file requests for direct member reimbursement and redirect them to the appropriate team member/department.
Maintain physical copies of all paper correspondence received by the claims department.
E-file medical records received for review and redirect them to the appropriate team member/department.
Manage the overpayment letter tracker, ensuring timely mailing and notifying the appropriate team member when letters age to 45 days.
Work incoming mail and scan documents for internal or other area sharing.
Communicate process changes, project status, and issue resolutions through email, group presentations, and individual meetings.
Handle undeliverable mail, verify and update mailing addresses for providers, including making outbound calls to request updated W-9s and uploading them to the provider management system.
Interface with providers via telephone and written correspondence to respond to inquiries and resolve concerns.
Perform other duties as assigned or needed.

Competencies:

Analytical Skills: Synthesize complex information, collect and research data, and demonstrate attention to detail.
Problem Solving: Identify and resolve problems timely, gather and analyze information skillfully, develop alternative solutions, and work well in group problem-solving situations.
Customer Service: Manage difficult or emotional customer situations, respond promptly to customer needs, solicit feedback to improve service, and meet commitments.
Interpersonal Skills: Focus on solving conflict, maintain confidentiality, listen without interrupting, remain open to others' ideas, and try new things.
Communication: Speak clearly and persuasively, respond well to questions, write clearly and informatively, edit work for spelling and grammar, and present numerical data effectively.
Teamwork: Balance team and individual responsibilities, exhibit objectivity and openness to others' views, contribute to building a positive team spirit, and support everyone's efforts to succeed.

Qualifications:

Education and/or Experience: High School Diploma or GED Equivalent required. At least 3 years of previous experience in Managed Care and Medicare preferred.
Language Skills: Ability to read and interpret documents, write routine reports and correspondence, and speak effectively before groups.
Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, compute rate, ratio, and percent, and draw and interpret bar graphs.
Reasoning Ability: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions and deal with problems involving a few concrete variables in standardized situations.
Computer Skills: Expert working knowledge of Microsoft Office software, including Excel and Word, as well as MS Internet Explorer.

Job Type: Full-time

Pay: $15.32 - $18.00 per hour

Expected hours: 40 per week

Benefits:

401(k)
401(k) matching
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance

Schedule:

Day shift
Monday to Friday

Work setting:

Remote

Experience:

Microsoft Office: 1 year (Required)
Customer service: 1 year (Required)

Work Location: Remote

CSTS Customer Service and Technology Solutions LLC

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