Claims Examiner

BCforward is currently seeking a highly motivated Claims Representative Role at Trenton, NJ.
Position Title: Claims Representative
Location: Trenton, NJ.
Anticipated Start Date: Tentative start Date 05/20/2024.
Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.
Expected Duration: 12+ Months with a Strong possibility of Extension.
Job Type: Contract 40hr week/Onsite
Pay Range: $22/hr to $26/hr on W2.
(Please note that actual compensation may vary within this range due to factors such as location, experience, and job responsibilities, and does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).
Job Description:

• Follows adjudication policies and procedures to ensure proper payment of claims.
• Resolves pending claims based on Medicaid rules and regulation established for final processing.
• Resolves claims resolution and/or adjustments/voids.
• Processes claim adjustments through Reversal/Replacement requests submitted by providers.
• Prices claims manually as required by Medicaid rules and system limitations as defined by policy and departmental procedures.
• Meets established production requirements consistently.
• Maintains an accuracy rate of 98% or better.
• Processes financial transactions.
• Review/Resolve LTC Production Reports.
• Data entry of LTC transactions.
• Monitor processing time & unfinished work on a daily basis.
• Process refund/return checks.
• Assist with monthly distribution of LTC TADS.
• Contributes a positive attitude to the team in order to meet department goals.
• Supports all departmental initiatives in improving overall efficiency.
• Assist in monitoring and timely processing of special batches

Requirements

• Basic knowledge of Microsoft Office Outlook, Word and Excel
• General knowledge of PC
• Good working knowledge of medical claims systems
• Knowledge of CPT/HCPCS and ICD9 coding procedures and guidelines
• Mathematical background a plus
• Good verbal and written communication skills
• Ability to abide by Gainwell Technologies policies
• Maintain regular attendance based on agreed-upon schedule
• Maintain confidentiality and comply with Health Insurance Portability and
• Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective working relationships with
• coworkers, clients, members, providers and customers

Benefits:
BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.
Keywords:
Claims Representative/ Claims Analyst/Claims
About BCforward:
Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.
BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.
BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.
To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.
This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Interested candidates please send resume in Word format Please reference job code 222282 when responding to this ad.