Payment Integrity Claims Administrator

6 Degrees Health is a rapidly growing, nationally positioned cost containment company in the self-funded health insurance industry. Through accountability, engagement, and continuous improvement, we leverage passion and exemplary customer service to support our stakeholders in making informed financial decision about healthcare reimbursement. Our team of industry experts work with health plans to make the most of their healthcare dollars. We are looking for the right candidate to join our team as a Payment Integrity Claims Administrator. This position is a remote position.

Job Summary

Reviews insurance claims forms and documents for accuracy and completion and obtains missing information as necessary. Supports clinical department through claims routing and finalization, workflow management and task tracking and quality document tracking.

Essential Role Responsibilities

• Enters manual claims to the claims system
• Work collaboratively with the Claims Team to identify process gaps and improve procedures
• Manages incoming manual claims from multiple clients to our secure server
• Communicates data from Salesforce to the rest of the team via recurrent reporting
• Maintain up to date healthcare industry policies and regulations
• Administrator of shared email inbox, routing messages and claims as appropriate and assuring task completion
• Clearly document claims process and issue resolution
• Monitor incoming and outgoing electronic claims via our internal processing system
• Works collaboratively with other departments to provide updates on claims status
• Provide detailed reporting on claims volume, billed charges, savings, etc.
• Research claim questions to properly route inquiries
• Other responsibilities or projects as assigned
• Finalizes claim reviews including client and provider report preparation
• Work includes the exercise of discretion and independent judgment with disbursement of mail which includes provider appeals and medical claims, disbursement of TPA, Plan and provider emails and discretion and independent judgement with medical claims in EDI that need additional research
• Maintains records of all direct provider and client contacts
• Support a culture that is consistent with 6 Degrees Health values and beliefs

Minimum Role Requirements

• 3-5 years of healthcare experience
• Associate degree or higher preferred
• Expert user of Microsoft suite including Excel, Word, Visio and PowerPoint
• Excellent verbal and written communication skills

Essential Role Functions

• Must have the ability to read and understand various process flows and procedures
• Must be willing and able to work a 5-day schedule and additional hours beyond regularly scheduled shift to cover vacancies, if necessary
• Must be able to operate computers and phones to support position requirements
• Strong Microsoft Office Skills are a must
• Must be able to sit or stand for two hours at a time
• Strong internal and external communication skills, both verbal and written

Organizational Benefits

• 401k Program
• 10 Paid Holidays
• Training and Development Opportunities
• Remote Work Stipend
• Unlimited Paid Time Off
• Medical, Dental, Vision and Other Outstanding Ancillary Benefits

The base salary range for this position is between $38,000 and $50,000 plus benefits. Please note that the base salary range is a guideline, and that individual compensation will vary based on factors such as overall qualifications, skillsets, competencies, and work location.

At 6 Degrees Health, we understand that an outstanding team is the building block of any organization. With a solid foundation, achieving our goals becomes a reality. We are dedicated to creating a safe and inclusive environment for our employees, and those in our communities, and we believe that our community is stronger when everyone is included and appreciated. We are committed to learning, listening, and improving, while celebrating the diversity and humanity of all people. We are committed to providing opportunities for engagement in decision making and ensuring safe transparency to express and challenge ideas.

6 Degrees Health, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.

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