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Every day, Kelly Services connects professionals with opportunities to advance their careers. We currently have exciting Temp-To-Hire opportunities for Claims Specialist in Wichita Falls, TXBASIC FUNCTION:Under supervision, this position is responsible for processing complex claims requiring further investigation, including coordination of benefits, and resolving pended claims.ESSENTIAL FUNCTIONS:This position is responsible for one or more of the following:
Process complex claims in various queues. Conduct research and investigation into missing information, make phone calls to providers, access resource materials and support files in order to process and adjudicate claims timely and accurately.
Resolve complex pended claims, duplicate claims and adjustments.
Process claims, involving communications with participating plans and/or Service Units. Resolve various issues.
Research and identify other insurance, Medicare, Medicaid and update patient file as needed.
Coordinate benefits; request explanation of benefits as needed.
Maintain a working understanding of medical terminology and CPT, HCPCS, and ICD9 coding.
Maintain knowledge of pre-existing condition and waiting period requirements as they relate to specific contracts. Resolve error messages as they relate to pre-existing conditions.
Read appropriate files in IMAGE and apply information to claims as needed using the Financial Suspense System (FSS).
Prepare reports.
Maintain files and records.
Learn and maintain knowledge of DOL ERISA and prompt pay legislation.
Assist with testing system changes and enhancements.
Periodic overtime may be required at the sole discretion of the employer based on business need.
Communicate and interact effectively and professionally with co-workers, management, customers, etc.
Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
Maintain complete confidentiality of company business.
Maintain communication with management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.
JOB REQUIREMENTS :
High School diploma or GED.
Data entry and/or typing experience.
Clear and concise written and verbal communication skills.
Experience processing medical claims.
Ability to multi-task and prioritize.
This is not a local branch position.Please DO NOT call the local branch, if interested respond to this posting and attach your resume.Apply Now! Please contact Dawnielle, Commercial Recruiter with Kelly, IMMEDIATELY.If not interested in the positions or know someone who is, please contact Dawnielle Jackson directly at dawnielle.jackson@kellyservices.com.Email resume: Dawnielle.jackson@kellyservices.comWhy Kelly ® ?At KellyServices ® , we work with the best. Our clients include 95 of the Fortune100 ™ companies, and more than 70,000 hiring managers rely on Kelly annually to accessthe best talent to drive their business forward. If you only make one career connection today, connectwith Kelly.AboutKelly Services ®As a workforce advocate for over 70 years, we are proud to directly employ nearly 500,000 peoplearound the world and have a role in connecting thousands more with work through our global network oftalent suppliers and partners. Revenue in 2017 was $5.4 billion. Visit kellyservices.com and connect with us on Facebook, LinkedIn and Twitter .Kelly Services is an equal opportunity employer including, but not limited to, Minorities, Females,Individuals with Disabilities, Protected Veterans, Sexual Orientation, Gender Identity and iscommitted to employing a diverse workforce. Equal Employment Opportunityis The Law.
