Revecore has been at the forefront of specialized claims management, helping healthcare providers recover meaningful revenue to enhance quality patient care in their communities. We’re powered by people, driven by technology, and dedicated to our clients and employees. If you’re looking for a collaborative and diverse culture with a great work/life balance, look no further.
Health Claims Specialist
Location
United States
Posted
23 hours ago
Salary
$18 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Health Claims Specialist
Revecore
Role Description As a Health Claims Specialist at Revecore, you will: - Bill and investigate health insurance claims to ensure maximum payment from insurance companies on behalf of our clients (hospitals and medical providers). - Investigate and research health insurance claims. - Follow up on unresolved claims to facilitate payment for commercial health, Medicare, and Medicaid. - Contribute to your team with various denial reports, audits, and overall support. Qualifications - Has experience researching and resolving claims for commercial health, Medicare, and Medicaid. - Knows how to file correct UB04's and 1500 HCFA's with subrogation information to payers for payment. - Familiarity with billing health insurance as part of auto accidents. - Conducts timely follow-up activities to determine claim status and collect and/or provide information to resolve the claim. - Experience working in EPIC. - Working knowledge of Microsoft Office (Word, Excel, Outlook). - Possess technical proficiency to work on multiple computer screens and software applications simultaneously. - Can maintain strong performance in a fast-paced environment with productivity metrics. Requirements - A private, distraction-free environment to work within your home. - On-Camera Presence: Being on camera is an essential part of our culture. - A secure internet connection. - Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads. - Workspace area must accommodate all workstation equipment (laptop, monitor, keyboard, mouse, docking station, and headset). - Employment is contingent upon eligibility to work in the U.S., employment history verification, and a background check. - Must reside in the United States within one of the specified states. Benefits - Paid training and incentive plans. - Medical, dental, vision, and life insurance benefits available on day 1. - Excellent work/life balance. - Employee Resource Groups build community and foster a culture of belonging and inclusion. - 401(k) contributions matched. - Career growth opportunities. - 12 paid holidays and generous paid time off.
Related Guides
Related Categories
Related Job Pages
More Claims Specialist Jobs
Claims Representative II, Property
Co-operatorsAll your investing and insurance needs in one place. 🍁Proudly Canadian since 1945.
Role Description As a Property Claims Representative II, you will be responsible for the investigation, negotiation, and resolution of complex property, farm, and commercial claims. You will contribute to our client service culture through daily interactions with clients and by implementing innovative, client-centric solutions. - Investigating, interpreting coverage, negotiating, and making decisions autonomously to resolve complex property, farm, and commercial claims. - Evaluating damage and preparing estimates on property losses, including attending the scene of the loss. - Collaborating with vendors and government officials to facilitate settlement of the loss. - Coaching, training, and providing technical support to the claims team. - Providing exceptional client service in accordance with our claims service and quality standards, with the view of enabling the organization to be the industry leader in client engagement. Qualifications - Three to five years of field property claims experience or related field. - Post-secondary degree or diploma. - Chartered Insurance Professional (CIP) designation or working towards it. - Provincial adjuster license(s) depending on the province of work. Requirements - Regular travel is required. - This role involves direct contact with clients and/or service providers in their environment. - Extended work hours, including evenings and weekends, will be required during peak periods and major events. - Background check as a condition of employment for the successful candidate. Benefits - Training and development opportunities to grow your career. - Flexible work options and paid time off to support personal and family needs. - A holistic approach to well-being, with physical and mental health programs and a supportive workplace culture. - Paid volunteer days to give back to your community. - Comprehensive total rewards package including group retirement savings plans, pension, and benefits (e.g., health and wellness, dental, disability, and life coverage), mental health support, and an employee assistance program. Salary Information Expected salary range: $60,574 to $100,956. The salary amount for the successful candidate is determined by Co-operators in its discretion and will vary depending on several criteria including but not limited to: local market conditions, geography, and relevant job-related factors such as knowledge, skills, qualifications, experience, and education. Employees may also have the opportunity to participate in incentive programs and earn additional compensation tied to individual and/or business performance, or other business metrics.
• Investigate and document property claims, including policy review, recorded statements, assigning inspections, updating reserves, preparing or reviewing estimates, and negotiating settlements • Communicate claim updates and decisions verbally and in writing • Handle claims in compliance with all applicable regulations and internal processes • Act as a resource for less experienced staff • Support catastrophe response as needed, to include potential overtime and deployment • Any other duties needed to help drive our purpose and fulfill our values
• Analyze New York Workers Compensation Lost-Time claims on behalf of our valued clients to determine benefits due. • Ensure ongoing adjudication of claims within service expectations and industry best practices. • Investigate and gather information to determine exposure on the claim. • Negotiate settlement of claims within designated authority. • Communicate claim activity and processing with the claimant and the client. • Report claims to the excess carrier and respond to requests of directions in a professional and timely manner.
• Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim • Manages claims through well-developed action plans to an appropriate and timely resolution • Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions • Negotiates claim settlement up to designated authority level • Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life • Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement • Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients • Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost • Represents Company in depositions, mediations, and trial monitoring as needed • Communicates claim activity and processing with the client; maintains professional client relationships • Ensures claim files are properly documented and claims coding is correct • Refers cases as appropriate to supervisor and management • Delegates work and mentors assigned staff



