Remote Claims Adjuster - $30/Hour

Role Overview:

• Compensation: Competitive hourly rate of $30/hour
• Company: Workwarp (representing Aeetna)
• Start Date: Immediate openings available
• Location: Remote
• Position: Remote Claims Adjuster

At Workwarp, we believe in empowering individuals to make a real difference. As a Remote Claims Adjuster, you'll play a vital role in ensuring accessible, affordable, and personalized healthcare. You'll contribute to a positive impact on people's lives by expertly handling claims and providing exceptional service.

Responsibilities:

• Review and process claims, ensuring accuracy and adherence to established guidelines.
• Investigate and resolve complex, sensitive, and unique claims according to guarantee handling rules.
• Negotiate supplier discounts and manage returns.
• Respond to customer inquiries and resolve issues with professionalism and efficiency.
• Apply technical and guarantee handling skills across all dollar levels of customer support platforms.
• Utilize clinical need guidelines to determine coverage, verify eligibility, identify discrepancies, and apply cost control measures.
• Perform guarantee re-work calculations and resolve claim excesses, underpayments, and anomalies.
• Manage complex, non-routine supplier discounts and inquiries.
• Review and interpret clinical agreement language to identify potential overpayment opportunities.
• Handle phone and written requests related to pre-endorsements, re-evaluations, and other inquiries.
• Ensure all consistency requirements are met and payments are processed according to company policies and procedures.
• Review and address relevant communications to the team that may impact claims.
• May provide mentorship and guidance to less experienced team members.
• Utilize available resources to manage workload and meet deadlines.

Qualifications:

• Prior experience in a fast-paced production environment.
• Proven ability to manage multiple tasks with accuracy and efficiency.
• Excellent written and verbal communication skills, with strong interpersonal abilities.
• Experience in claims handling is essential.

Desired Skills:

• Experience with DG system claims processing.

Ready to Apply?

If you are a motivated and detail-oriented individual eager to contribute to a dynamic team, we encourage you to apply! We look forward to reviewing your application.