It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

JOB SUMMARY:

Responsible for the accurate and timely processing of claims. Must meet published quality and productivity standards. Also, responsible for simple adjustments to previously processed claims.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

EDUCATION:

• High School degree or equivalent required.
• Associate degree or some college coursework preferred.

EXPERIENCE:

• Two years or more years experience in managed care claims processing preferred.

COMPETENCIES, SKILLS, AND ATTRIBUTES:

• Working knowledge of medical terminology as well as CPT4, HCPCS and ICD9 coding sets and HIPAA regulations.
• Knowledge of Microsoft Office and FACETS preferred.
• Ability to maintain production level and quality goals.
• Follow through on commitments and meets deadlines
• Work is thorough, accurate, and effective.
• Demonstrates ability to complete assigned work in a timely fashion.

• Evaluates and processes claims in accordance with company policies and procedures according to productivity and quality standards.
• Interprets and processes routine and less complex claims including CMS 1500 and UB04.
• Reviews and analyzes data from system-generated reports for in-process claims in order to identify and resolve errors prior to final adjudication.
• Alerts claims management to claims aging issues as well as provider billing problems.
• Maintains current knowledge of company members’ benefits, policies/procedures, provider network development and contract issues, processing system issues, Massachusetts Medicaid regulations, as well as industry standards for claims adjudication.
• Consistently maintains production standards based on transactions/units per hour
• Consistently meets quality standards