Claim Lead Representative, Payer Solutions - Evernorth- Remote

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* Any Work at Home Location is Acceptable for This Position

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Responsibilities:


* Researches, analyzes and calculates claims in accordance with provider contracts


* Works with internal matrix partners to resolve pended claims/tickets issues


* Utilizes our SRS system to route work items to matrix partners and external retailer claim administration staff


* Follow audit protocols and workflows to ensure quality goals.


* Special pricing projects as requested by retailers


* Partners with matrix organizations to ensure that appropriate action is taken to identify and implement high potential process improvements


* Supports and drives process improvement to further enhance claim accuracy outcomes


* Engagement, partnership with supervisor, claim processing team, and other internal and external partners


* Position requires excellent interpersonal skills; ability to understand and interpret policy provisions, and to present report analysis and meaningful findings in a clear, concise way.


* Pricing identification of errors and management of resolution with provider contracting/maintenance internal teams.


* Identifies steps necessary to process a varying complexity of contracts for pricing accuracy

Qualifications:


* 1 year of Payer Solutions claim processing technical knowledge and application


* Customer Service Driven; ability to meet and exceed the internal partner and external customer expectations


* Take accountability in critical thinking and decision-making outcomes


* Problem solving skills; utilization of technical skills and resources to ensure accuracy of final claim resolution


* Strong communication skills, both verbal and written


* Ability to teach, educate, coach others through a variety of claim complexities


* Process improvement skills; ability to assess trends, processes, and barriers to drive positive outcomes for claim resolutions


* Fluent understanding and application of key tools and resources for claim processing; C-Kit 2.0, Calculators, CPF/PWB, SANP, Facets, etc.


* Comfortable working with others in multiple locations; office and work at home


* Basic knowledge with Word, Excel, PowerPoint, WebEx and Outlook preferred

If 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 22 - 33 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 incl...