Role Description Process all MVH overseas claims from receipt through resolution in accordance with MVH regulations, guidelines, and quality standards, with expertise in coordination of benefits (COB), DEERS eligibility, and claims development. - Process all MH overseas claim types by determining corrective action to be taken on various types of errors pended by edit system and resolving interactive edits. - Translate, research, and verify claims information to determine if all requirements have been met. - Review submitted claim information and select correct procedure code and diagnosis code using ICD-9, ICD-10, CPT4, and HCPCS manuals. - Obtain development information from external contacts and add successful development information to notepad via PC. - Access patient/sponsor files and update information accordingly. Qualifications - High School Diploma or GED or equivalent experience. - U.S. citizenship is required for this position due to Department of Defense restrictions. - One (1) or more years of experience in a claims processing role. - Demonstrated proficiency in data entry with a strong ability to maintain focus and accuracy. - Ability to effectively utilize available resources to further research and verify claims. - Strong written communication skills. - Demonstrates the ability to work independently and take initiative. Requirements - Ability to translate a foreign language. - Two (2) or more years of prior health insurance experience, i.e., Claims Processor, Customer Service Representative, or Billing Representative preferred. Benefits - Remote work available. - Performance bonus and/or merit increase opportunities. - 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately). - Competitive paid time off. - Health insurance, dental insurance, and telehealth services start DAY 1. - Professional and Leadership Development Programs.

• Determine compensability and/or coverage issues for loss time workers' compensation claims • Effectively manage a caseload of loss time claims from numerous jurisdictions • Negotiate and direct settlements under management's review • Gather medical and factual evidence to determine compensability • Direct outside investigation and handle litigation files within given authority • Coordinate and maintain contact with claimants and/or their attorneys, outside investigators, and rehabilitation personnel as well as routine contact with insureds, account liaisons and medical providers

• Determine compensability and/or coverage issues for loss time workers' compensation claims • Effectively manage a caseload of loss time claims from numerous jurisdictions • Negotiate and direct settlements under management's review • Gather medical and factual evidence to determine compensability • Direct outside investigation and handle litigation files within given authority • Coordinate and maintain contact with claimants and/or their attorneys, outside investigators, and rehabilitation personnel as well as routine contact with insureds, account liaisons and medical providers

Role Description We seek a meticulous and customer-focused individual to join our team as a Claims Processor. This role requires a combination of research acumen, attention to detail, and exceptional customer service skills. As a key member of our organization, you will be responsible for: - Processing medical claims accurately. - Conducting thorough audits to ensure compliance with regulations and policies. - Providing excellent service to our clients and healthcare providers. Key Responsibilities - Review and process medical claims submitted by members or providers promptly and accurately. - Verify the accuracy and completeness of claim information, including patient demographics, diagnoses, procedures, and billing codes when available. - Ensure compliance with insurance policies and industry standards. - Investigate and resolve any discrepancies or issues related to claim submissions. - Conduct comprehensive medical claims audits to identify errors, discrepancies, or fraudulent activities. - Analyze claim documentation, including medical records and billing statements, to ensure adherence to coding guidelines and reimbursement policies. - Research complex medical billing and coding issues to support claims processing and audit activities. - Interpret coding guidelines, reimbursement policies, and legal requirements to determine appropriate claim adjudication. - Provide recommendations for improving claims submission procedures and enhancing reimbursement accuracy. - Serve as members' primary point of contact regarding claims inquiries and resolution. - Respond promptly to customer inquiries and concerns with professionalism and empathy. - Collaborate with cross-functional teams to address customer issues and ensure timely resolution. Qualifications - Strong knowledge of medical terminology, medical coding, and insurance billing practices. - Excellent analytical skills with the ability to interpret complex healthcare regulations and guidelines. - Exceptional attention to detail and accuracy in data entry and documentation. - Effective verbal and written communication skills with a customer-centric approach. - Ability to work independently and collaboratively in a fast-paced, deadline-driven environment. - Excellent verbal, written and interpersonal communication skills. - Must be a self-motivator and self-starter. - Exceptional listening and analytical skills. - Solid time management skills. - Ability to multitask and successfully operate in a fast-paced, team environment. - Must adapt well to change and successfully set and adjust priorities as needed. Education/Experience - High School Diploma or equivalent. - Proven experience in medical claims processing and healthcare reimbursement. Technical Knowledge - SalesForce Experience. - Google Suite Experience. - Claims Management Software experience. Benefits - Competitive salary and benefits package. - Dynamic and innovative work environment. - Opportunities for professional growth and development. - Remote work.