One of the largest nonprofit, academic, multi-specialty medical groups in RI.
Claims Follow Up Rep TC
Location
United States
Posted
99 days ago
Salary
$20 - $33 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Claims Follow Up Rep TC
Brown Medicine
SUMMARY: Under general supervision of the Claims Administration Follow-up Supervisor, perform all clerical duties necessary to properly process patient bills to customers taking appropriate follow-up steps to obtain timely reimbursement of each 3rd party claim and ensure the financial stability of the Hospital. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate RESPONSIBILITIES: Consistently applies the corporate values of respect, honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a comprehensive integrated academic health system. Responsible for knowing and acting in accordance with the principles of the Brown University Health Corporate Compliance Program and Code of Conduct. Review claim forms for all required data fields depending on the specific 3rd party requirements. Review patient account for demographic accuracy. Process all necessary system adjustments or changes as needed, such as adding/deleting insurance information, insurance priority changes, balance transfers, demographic changes, contractual allowances, and any other routine patient accounting adjustments not requiring supervisory approval ensuring accurate financial data. Analyze all assigned claims received from various sources to ensure accurate and timely reimbursement based on the individual payer’s contracts or Federal reimbursement methods. Contact insurer via online systems, call centers, written correspondence, fax or appropriate electronic or paper billing of claims to secure payment. Maintains an understanding of the most current contract language in order to consistently ensure reimbursement in accordance with contract language. Continually maintains knowledge of payer specific updates via payer’s listservs, provider updates, webinars, meetings and websites. Review payer’s settlements for correct reimbursement and proceed with contact to insurer if claim is not adjudicated correctly based on working knowledge of the various payer’s policies and each individual related contract. Identifies and analyzes denials and payment variances and enacts corrective measures as needed to effectively communicate and resolve payer errors. Understands and maintains compliance with HIPAA guidelines when handling patient information Initiate adjustments to payer’s as appropriate after analyzing under or over payments based on contract, Federal regulation, late charge corrections or inappropriate denials. Submits appeals to payers as appropriate to recover denied revenue Contact internal departments to acquire missing or erroneous information on a claim resulting in adjudication delays or denials. Run reports as necessary to quantify various variances on patient accounts related to identified issues within the payers or as the result of known charging errors or procedural breakdown. Reports to supervisor identification of trends resulting in under/over payments, inappropriate denials or charging/billing discrepancies. Answer telephone inquiries from 3rd parties and interdepartmental calls. Refer all unusual requests to supervisor. Retrieve appropriate medical records documentation based on third party requests. Initiate the accurate and timely processing of all secondary and tertiary claims as needed according to specific 3rd party regulations. Process all incoming mail and follow up on all rejections received according to specific 3rd party regulations. Refer all accounts to supervisor for additional review if the account cannot be resolved according to normal patient accounting procedures. Works with supervisor, management and the patient accounting staff to improve processes, increase accuracy, create efficiencies and achieve the overall goals of the department. Maintain quality assurance, safety, environmental and infection control in accordance with established policies, procedures, and objectives of the system and affiliates. Perform other related duties as required. WORK LOCATIONS/EXPECTIONS: After orientation at the Corporate facilities, work is performed based on the following options approved by management and with adherence to a signed telecommuting work agreement and Patient Financial Services Remote Access Policy and Procedure.. Full time schedule worked in office Full time schedule worked in a dedicated space in the home Part time schedule in office and in a dedicated space within the home Schedules must be approved in advance by management who will allow for flexibility that does not interfere with the ability to accomplish all job functions within the said schedule. Staff are required to participate in scheduled meetings and be available to management throughout their scheduled hours. Staff must be signed into Microsoft Teams during their entire shift and communicate with Supervisor as directed. MINIMUM QUALIFICATIONS: BASIC KNOWLEDGE: Equivalent to a high school graduate Knowledge of 3rd party billing to include ICD, CPT, HCPCS, UB and HCFA 1505 claim form Demonstrated skills in critical thinking, diplomacy and relationship-building Highly developed communication skills, successfully demonstrated in effectively working with a wide variety of people in both individual and team settings Demonstrated problem-solving and inductive reasoning skills which manifest themselves in creative solutions for operational inefficiencies. EXPERIENCE: One to three years of relevant experience in medical collections or professional/hospital billing preferred INDEPENDENT ACTION: Incumbent generally establishes own work plan based on pre-determined priorities and standard procedures to ensure timely completion of assigned work. Problems needing clarification are reviewed with supervisor prior to taking action. SUPERVISORY RESPONSIBILITY: None Pay Range: $19.97-$32.96 EEO Statement: Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment. Location: Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903Work Type: Monday-Friday 8:00am - 4:30pmWork Shift: DayDaily Hours: 8 hoursDriving Required: No
Related Guides
Related Categories
Related Job Pages
More Claims Specialist Jobs
Casualty Claims Specialist
Liberty MutualLiberty Mutual is a leading global insurance corporation and one of the largest casualty and property insurance companies in the nation. In the past, Liberty Mu
Role Description Join our team this June 2026! Liberty Mutual’s Personal Lines Casualty team is hiring experienced Claims Specialist to manage attorney‑represented and litigated auto and homeowner bodily injury claims. If you have strong litigation experience, sound judgment, and a commitment to excellent customer service, we want to hear from you. Advance your career with a supportive team and meaningful work that makes a difference. Apply today! - Manages, investigates, and resolves claims. - Investigates and evaluates coverage, liability, damages, and settles claims within prescribed authority levels. - Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation. - Prepares for and attends trials, hearings and conferences and reports to Home Office and local management on status. - Confers with trial counsel and prepares trial reports. - Communicates with policyholders, witnesses, and claimants to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advises on proper course of action. - Responds to various written and telephone inquiries including status reports. - Ensures adequacy of reserves. - Recommends reserve increases on cases in excess of authority. - Accountable for security of financial processing of claims, as well as security information contained in claims files. - Updates files and provides comprehensive reports as required. - Responsible for managing the practices and billing activities of outside and in-house counsel. - Expected 10% travel for trials, mediations, and in-person events. Qualifications - Strong written and oral communications skills required. - Strong interpersonal, analytical, negotiation and investigative skills required. - Customer service experience preferred. - Strong competency of legal liability, general insurance policy coverage and State Tort Law. - The capabilities, skills and knowledge required is normally acquired through a Bachelor's degree or equivalent experience and at least 3 years of directly related experience. - Ability to obtain proper licensing as required. Requirements - 2+ years of First Party Claims handling. - 2+ years of Personal Lines Third Party Auto Casualty experience. - 2+ years of Litigation experience. - This is a fully remote opportunity for candidates who live more than 50 miles from our claims offices. - Candidates who reside within a 50 mile radius will go into the office 2 times per month. - The following states are excluded from eligibility: California, Idaho and Washington.
Authorization Specialist II
Centene CorporationTransforming the health of the communities we serve, one person at a time.
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Remote opportunity but must reside in the state of Mississippi. Position Purpose: Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access. - Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines. - Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination. - Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment. - Performs data entry to maintain and update various authorization requests into utilization management system. - Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer. - Remains up-to-date on healthcare, authorization processes, policies and procedures. - Performs other duties as assigned. - Complies with all policies and standards. Education/Experience: Requires a High School diploma or GED. Requires 1 – 2 years of related experience. Knowledge of medical terminology and insurance preferred. Pay Range: $17.84 - $28.02 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Claims Examiner II
The Baldwin GroupCAC, part of The Baldwin Group, is a leading insurance broker and advisor that provides expertise and placement capabilities across the spectrum of insurance and capital markets. Our team defines our success. We recruit and retain the industry’s best talent with deep knowledge and experience in their respective segments, products, and industries. We root for each other, as we are all connected and aligned to serving clients in a better and smarter way.
• Analyzes insurance policies and other documents to determine insurance coverage. • Investigates and analyzes claim information to determine extent of liability. • Handles claims 1st Party Property Claims of a high level of complexity. • Engage experts to assist in the evaluation of the claim. • Communicates with all interested parties throughout the life of the claim.
Claims Examiner II- MSI
MSI, part of The Baldwin GroupWhy MSI? We thrive on solving challenges. As a leading MGA, MSI combines deep underwriting expertise with insurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers’ unique needs. We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products – from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property – delivered through agents, brokers, wholesalers and other brand partners. Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle. Bring on your challenges and let us show you how we build insurance better.
Why MSI? We thrive on solving challenges. As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers’ unique needs. We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products – from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property – delivered through agents, brokers, wholesalers and other brand partners. Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle. Bring on your challenges and let us show you how we build insurance better. The Claims Examiner II is considered an expert in managing insurance claims for our policyholders, handling claims with a higher level of complexity. The Claims Examiner II must have technical knowledge in insurance claims handling and the skills needed to provide superior service for our customers. The ability to develop relationships and effectively communicate with a diverse range of clients, carriers and colleagues is a key success factor in this role. Strategic vision coupled with tactical execution to achieve results in accordance with goals and objectives is also critical to the overall success of this position PRIMARY RESPONSIBILITIES: • Analyzes insurance policies and other documents to determine insurance coverage. • Investigates and analyzes claim information to determine extent of liability. • Handles claims 1st Party Property Claims of a high level of complexity. • Assist in suits, mediations and arbitrations. Works with Counsel in the defense of litigation. • Sets timely, adequate reserves in compliance with the company’s reserving philosophy. • Engages experts to assist in the evaluation of the claim. • Monitors vendor performance and controls expense costs. • Evaluates, negotiates and determines settlement values. • Communicates with all interested parties throughout the life of the claim. Proactively discusses coverage decisions, the need for additional information, and settlement amounts with interested parties. • Handles all claims in accordance with Best Practices. • Responsible for monitoring and completing assigned claims inventory. • Acquire and maintain a state adjuster’s license and meet state continuing education requirements. • Provides Best-In-Class customer service for insureds and agents. • Updates and maintains the claim file. • Identifies opportunities for subrogation and ensures recovery interests are protected. • Identifies fraud indicators and refers files to SIU for further investigation. • Participates in claims audits, internal and external. • Provides oversight of TPAs KNOWLEDGE, SKILLS & ABILITIES: EDUCATION & EXPERIENCE: High School/GED 5-9 years' experience in claims Must have Property & Casualty Insurance License #LI-JW2 #LI-REMOTE Click here for some insight into our culture!
