Transaction Processing - Claims Specialist

Job Description

About Conduent

Conduent delivers mission-critical services and solutions on behalf of businesses and governments creating exceptional outcomes for its clients and the millions of people who count on them. Through people, process and technology, Conduent solutions and services automate workflows, improve efficiencies, reduce costs and enable revenue growth. It’s why most Fortune 100 companies and over 500 government entities depend on Conduent every day to manage their essential interactions and move their operations forward.

 

Conduent’s differentiated services and solutions improve experiences for millions of people every day, including two-thirds of all insured patients in the U.S., 10 million employees who use its HR Services, and nearly nine million people who travel through toll systems daily. Conduent’s solutions deliver exceptional outcomes for its clients including $16 billion in medical bill savings, up to 40% efficiency increase in HR operations, and up to 40% improvement in processing costs, while driving higher end-user satisfaction. Learn more at www.conduent.com.


Job Description

M-F 8:00am - 5:00pm

Hourly rate $13/hr

 

The Claims Specialist is responsible for the processing all adjustments transactions and accurately and timely working Edit Locations according to contractual requirements. This may include personal contact with providers and billing agencies through phone work. This position may also require for the specialist to assist with other duties in the department as assigned by the Claims Supervisor or Claims Manager.

 

MAJOR POSITION RESPONSIBILITIES:

·         Assist in opening/sorting incoming mail.

·         Log checks into system.

·         Assist with folding and stuffing letters.

·         Screen internal and external adjustment requests for compliance with guidelines and contract requirements.

·         Enter batch control records into the MMIS.

·         Prepare requests for scanning.

·         Assist with scanning of documents as necessary.

·         Enter adjustment requests into the MMIS, making necessary adjustments as requested within the guidelines of Wyoming Medicaid.

·         Process all suspended adjustment transactions (pending and suspended transaction edits) according to internal and contractual requirements.

·         Prepare and log documents to be returned to the provider.

·         Process all claims suspended in locations assigned to the Adjustments Department according to internal and contractual requirements.

·         Meet Quality Control and production standards of Claims Department.

·         Assist throughout department when needed.

·         Cover breaks and lunches of receptionist.

·         Other duties as assigned.

 

QUALIFICATIONS;

 

·         Hs Diploma or GED

·        Experience with Wyoming Medicaid and the MMIS preferred

·         Ability to work in a production environment, working quickly and accurately in resolving pended adjustment transactions.

·         Strong analytical, comprehension, and problem-solving skills.

·         Strong mathematical skills.

·         Must be able to work overtime when required.

·        Ability to follow oral and written instructions and directions.

·         Personal computer experience

·         Strong customer service skills.

·         Must be detailed oriented.

·         Must have good organizational skills and decision-making ability.

·        Must be able to work independently and as a team


Closing

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form.