Job description

Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our medlogix® technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients’ needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; third party administrators (TPAs); and government entities we serve.

Position: Claims Processor

Location: 100% Remote

FMLA: Exempt, Full-Time

Schedule: M-F 8am-4:30pm

Job Description:

As a processor, you will be responsible for reviewing and processing insurance claims by verifying policy coverage, gathering necessary information, evaluating claim validity, and determining the appropriate payout amount based on policy terms, ensuring all documentation is complete and accurate while adhering to company guidelines and regulations. You will often interact with policyholders, agents, and other stakeholders to facilitate the claims process efficiently and ensure compliance with HIPPA regulations, including confidentiality. Ability to work in multiple claim systems and provide support to multiple departments, including litigation and legal departments.

Responsibilities:

Account Searches and police reports
Make initial contact and document file upon receipt of first notice of loss
Send appropriate claim forms to claimants, insureds, and/or representatives
Review file for proper reserves and document file
Request missing documentation needed to appropriately manage file
Provide support to litigation/legal departments with Disputes, Appeals, Pre-suits
Provide support with Post Service appeals, assignments, Dispute Awards Settlements and/or withdrawals
Make appropriate payments for awards, settlements, and interest where applicable
Ability to re-route documentation when a claim is not in system
Cycle time file reviews for missing or pending documents, open billing and file closure

Required Skills/ Abilities:

Excellent organizational skills and attention to detail
Conducts interactions with sensitivity, maturity and professionalism
Knowledge of claims systems and procedures
Excellent written and verbal communication skills
Ability to maintain confidential information
Comfortable in a high-volume, fast, team-oriented environment
Proficient in Microsoft Office Suite
Manage day-to-day operations to ensure SOPs are being followed as defined in our clients’ SLAs

Education and Experience:

Bachelor’s degree or relevant experience required
Prior carrier or adjuster experience
Knowledge of New Jersey No Fault PIP regulation, 2-3 years preferred
Minimum 2 years medical billing or claims processing background

EEOC STATEMENT:

Medlogix is an Equal Opportunity Employer. Medlogix does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. We will continue to maintain our commitment to making all employment-related decisions based on the merit of each individual.

Claims Processor- 100% Remote

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