Claims Examiner Senior \ 160

TalentBurst, Inc.

Irving, TX

JOB DETAILS
SALARY
$23–$24 Per Hour
SKILLS
Adjudication, Analysis Skills, Centers for Medicare and Medicaid Services (CMS), Claims Processing, Desktop PC, Durable Medical Equipment, Federal Compliance Regulations, Federal Laws and Regulations, Fee Schedule, Healthcare, Healthcare Providers, High School Diploma, Home Care, Insurance Claims, Laboratory Equipment, Maintain Compliance, Medical Records, Network Configuration Management, Quality Assurance, Regulatory Compliance, Systems Administration/Management, Team Lead/Manager
LOCATION
Irving, TX
POSTED
11 days ago
Claims Examiner Senior 
Irving TX 75039 - Onsite
Shift: 8 AM - 5 PM
Monday-Friday
Duration: 13+ Weeks


Notes: Proof of education; High School Diploma
Minimum of 3 years' experience processing medical claims in the healthcare industry.

The Claims Examiner Senior is responsible for reviewing, analyzing, researching, and resolving complex medical claims in accordance with claims processing guidelines and desktops, as well as, ensuring compliance with federal regulations. This role works in conjunction with Business Configuration, Network Management, Provider Data, Complaints, Appeals and Grievances as well as other operational departments to ensure validation and quality assurance of claims processing.

Responsibilities:
Meets expectations of the applicable Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
Analyze medical claim information and take appropriate action for payment resolution in accordance with policies and procedures, desktops, processing guidelines, and federal regulations.
Process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms from facilities, physicians, Home Health, Durable Medical Equipment providers, laboratories, etc.
Work claim projects resulting from overpayments or underpayments related to manual processing errors, benefit updates, and/or contract, fee schedule changes.
Process provider refunds, reconsiderations, and direct member reimbursements.
Process medical claim adjustments, recovery of claim overpayments, and execution of claim batch adjudication.
Solve moderately complex claims and escalate issues to the Claims Team Lead, Supervisor or Manager.
Assist with database improvements and testing for system upgrades, conversions, or implementation of new processes.
Serves as a resource to assist

#TB_PH
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Why TalentBurst?
At TalentBurst, we deliver more than talent, we deliver outcomes. We partner with you to move quickly and connect you to opportunities aligned with your skills and long term growth.

Backed by precision, transparency, and results, we connect top talent with leading organizations through trusted partnerships.

We offer competitive compensation and comprehensive benefits, including medical, dental, vision, and retirement options.

TalentBurst is an equal opportunity employer committed to an inclusive and diverse workforce.

About the Company

T

TalentBurst, Inc.

For over 20 years, TalentBurst Inc. has been an award-winning provider of cutting-edge Workforce Management Solutions. With a strong commitment to staying ahead in the tech landscape, we pioneer innovative approaches to talent acquisition. Our expertise spans Life Sciences, and Healthcare Staffing, Banking, Financial, IT, and Engineering, as well as Global Employer of Record (EOR), Agent of Record (AOR), State, Local Government and Education (SLED), and IC validation/compliance services. Additionally, our division, TalentProcure, leads the industry with offerings such as High Hazard Payroll, Managed Services, and Vendor on Premise (VOP) solutions.

Due to our prioritization of excellent standards, we are Joint Commission Certified and are a certified Minority Business Enterprise (MBE) in the USA and Canada. Supporting over 130 Fortune 500 companies globally, we excel in navigating the landscape of talent acquisition. In a world of constant change, we embrace developing people-centric solutions that address the unique demands of our clients. Stay connected by visiting our website and following us on social media!

 

COMPANY SIZE
5,000 to 9,999 employees
INDUSTRY
Staffing/Employment Agencies
FOUNDED
2002
WEBSITE
http://www.talentburst.com/