Claims Adjuster
Company: Sentara Health
Location: Miami
Posted on: April 17, 2024
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Job Description:
City/State
Doral, FL
Overview
Work Shift
First (Days) (United States of America)
AvMed, a division of Sentara Health Plans in the Florida market, is
hiring a Claims Adjuster in Miami and/or Gainesville, Florida. This
is a hybrid position, 2 days in office and 3 days remote.
Scope of position:The Claims Adjuster is responsible for performing
centralized appeal processing functions for AvMed physicians,
facilities, and ancillary providers. Identify claims problems and
propose solutions.
Essential Job Functions:
Minimum Requirements:
Preferred Requirements:
Our Benefits:
As the third-largest employer in Virginia, Sentara Health was named
by Forbes Magazine as one of America's best large employers. We
offer a variety of amenities to our employees, including, but not
limited to:
Sentara employees strive to make our communities healthier places
to live. We're setting the standard for medical excellence within a
vibrant, creative, and highly productive workplace. For information
about our employee benefits, please visit: Benefits - Sentara
(sentaracareers.com)
Join our team! We are committed to quality healthcare, improving
health every day, and provide the opportunity for training,
development, and growth!
Note: Sentara Healthcare offers employees comprehensive health care
and retirement benefits designed with you and your family's
well-being in mind. Our benefits packages are designed to change
with you by meeting your needs now and anticipating what comes
next. You have a variety of options for medical, dental and vision
insurance, life insurance, disability, and voluntary benefits as
well as Paid Time Off in the form of sick time, vacation time and
paid parental leave. Team Members have the opportunity to earn an
annual flat amount Bonus payment if established system and employee
eligibility criteria is met.
Keywords: Talroo-Health Plan, Claims, Auditing, QNXT
Job Summary
Responsible for all areas of customer service as it pertains to the
acquisition and/ or retention of members for Sentara Health Plan,
Inc. This includes functions associated with the administration of
all group information: processing of claims, interaction with
members, providers and employers. Special reports and projects to
include: initial review and analysis, recommendations, SBAR if
assigned, Research Team monthly/quarterly reports if assigned,
provider site visits/ conference calls if assigned, and new
technology testing as assigned.
CPC certification OR Related Medical Certification OR Associates
Degree (or higher) required
Qualifications:
HS - High School Grad or Equivalent (Required)
Certified Professional Coder (CPC) - Certification - American
Academy of Professional Coders (AAPC)
Administrative, Customer Service, Health Plan Claims
Disbursmnts
Skills
Microsoft Excel, Microsoft Word, Project Management,
Technology/Computer, Typing Speed 30+ WPM, Writing
Sentara Healthcare prides itself on the diversity and inclusiveness
of its close to an almost 30,000-member workforce. Diversity,
inclusion, and belonging is a guiding principle of the organization
to ensure its workforce reflects the communities it serves.
Per Clinical Laboratory Improvement Amendments (CLIA), some
clinical environments require proof of education; these regulations
are posted at ecfr.gov for further information. In an effort to
expedite this verification requirement, we encourage you to upload
your diploma or transcript at time of application.
In support of our mission to improve health every day, this is a
tobacco-free environment. Associated topics: adjuster, claim
examiner, claim investigator, damage, fraud, insurance
investigator, investigation, liability, liability adjuster, title
examiner
Keywords: Sentara Health, Fountainbleau , Claims Adjuster, Other , Miami, Florida
Click
here to apply!
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