Remote Claims Adjuster - $30/Hour

Role Overview:

Compensation: Competitive hourly rate of $30/hour
Company: Workwarp (representing Aeetna)
Start Date: Immediate openings available
Location: Remote
Position: Remote Claims Adjuster



At Workwarp, we believe in empowering individuals to make a real difference. As a Remote Claims Adjuster, you'll play a vital role in ensuring accessible, affordable, and personalized healthcare. You'll contribute to a positive impact on people's lives by expertly handling claims and providing exceptional service.


Responsibilities:


Review and process claims, ensuring accuracy and adherence to established guidelines.
Investigate and resolve complex, sensitive, and unique claims according to guarantee handling rules.
Negotiate supplier discounts and manage returns.
Respond to customer inquiries and resolve issues with professionalism and efficiency.
Apply technical and guarantee handling skills across all dollar levels of customer support platforms.
Utilize clinical need guidelines to determine coverage, verify eligibility, identify discrepancies, and apply cost control measures.
Perform guarantee re-work calculations and resolve claim excesses, underpayments, and anomalies.
Manage complex, non-routine supplier discounts and inquiries.
Review and interpret clinical agreement language to identify potential overpayment opportunities.
Handle phone and written requests related to pre-endorsements, re-evaluations, and other inquiries.
Ensure all consistency requirements are met and payments are processed according to company policies and procedures.
Review and address relevant communications to the team that may impact claims.
May provide mentorship and guidance to less experienced team members.
Utilize available resources to manage workload and meet deadlines.



Qualifications:


Prior experience in a fast-paced production environment.
Proven ability to manage multiple tasks with accuracy and efficiency.
Excellent written and verbal communication skills, with strong interpersonal abilities.
Experience in claims handling is essential.



Desired Skills:


Experience with DG system claims processing.




Ready to Apply?
If you are a motivated and detail-oriented individual eager to contribute to a dynamic team, we encourage you to apply! We look forward to reviewing your application.
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