2 Claims Experience Jobs

The Bilingual Specialist (Korean language) will be responsible for supporting local channel partners and their advertising partners. Your main tasks will include reviewing local brand-enhancing advertising to ensure compliance with requirements, verifying the utilization of qualifying funds, and managing co-op administration effectively. You will be expected to work the shift from 10 AM to 7 PM or adjust based on business requirements. Your key responsibilities will involve monitoring claims from initiation to completion, ensuring accurate information and supporting documentation, reviewing marketing materials against established guidelines and brand standards, conducting reviews of post-campaign activities, and communicating status updates to partners. Additionally, you will be responsible for reporting website functionality issues, resolving calls, emails, and chats, and appropriately documenting all communications. The ideal candidate should possess strong verbal and written communication skills in Korean and English, proficiency in Korean language translation and interpretation, and hold a Bachelor's or Post Graduate degree in a business or finance-related field. Prior experience in claims management, customer service in a fast-paced office environment, and technical proficiency in Microsoft Word, Excel, and Outlook are preferred. Attention to detail, excellent time management skills, the ability to multitask, meet deadlines, work collaboratively in a team setting, and independently in a remote-work environment are essential qualities for this role. A genuine curiosity and eagerness to learn are highly valued attributes. If you meet these qualifications and are enthusiastic about contributing to our team, we look forward to receiving your application.,

A career in our Managed Services team will provide you an opportunity to collaborate with a wide array of teams to help our clients implement and operate new capabilities, achieve operational efficiencies, and harness the power of technology. Our Revenue Cycle Managed Services team will provide you with the opportunity to act as an extension of our healthcare clients" revenue cycle functions. We specialize in front, middle and back office revenue cycle functions for hospitals, medical groups, and other providers. We leverage our custom and automated workflow and quality assurance products to enable our clients to achieve better results, which ultimately allow them to provide better patient care. To really stand out and make us fit for the future in a constantly changing world, each and every one of us at PwC needs to be a purpose-led and values-driven leader at every level. To help us achieve this we have the PwC Professional; our global leadership development framework. It gives us a single set of expectations across our lines, geographies and career paths, and provides transparency on the skills we need as individuals to be successful and progress in our careers, now and in the future. As an Associate, you'll work as part of a team of problem solvers, helping to solve complex business issues from strategy to execution. PwC Professional skills and responsibilities for this management level include but are not limited to: Minimum Degree Required: - Bachelors Degree Degree Preferred: - Bachelors Degree Required Field(s) Of Study: - Computer Science - Data Analytics - Accounting Preferred Field(s) Of Study: - Not specified Minimum Year(s) of Experience: - 2 years of experience Certification(s) Preferred: - Not specified Required Knowledge/Skills: - Not specified Preferred Knowledge/Skills: - The quality control analyst conducts quality control audits of patient accounts referred to the Revenue Cycle Managed Services (RCMS) and assures company and client standards are maintained and the integrity of client services are preserved. The Quality Control Analyst will perform a variety of functions including, but not limited to: reviewing and monitoring accounts, identifying problems, analyzing trends and suggesting recommendations for improvements. This role consults with and takes direction from the Continuous Improvement Specialist to resolve quality and efficiency issues that may occur on any given project. Required Years of Experience: - 2-4 years in medical collections, billing and/or claims experience, and customer service experience Responsibilities: - Perform quality control audits, review and monitor accounts - Identify problems, analyze cause and effect, and suggest recommendations for improvement - Provide daily constructive feedback based on account notation - Identify areas of weakness and communicate recommendations on changes and improvement to Continuous Improvement Specialists - Document findings of analysis, may prepare reports and suggest recommendations of implementation of new systems, procedures or organizational changes - Consult and collaborate with Continuous Improvement Specialist to identify and assess training needs based on work audited - Participate in quality control meetings - Possess considerable leadership skills, fostering an atmosphere of trust, seek diverse views to encourage improvement and innovation, coach and develop staff through timely and meaningful written feedback - Possess a cooperative and positive attitude toward management and co-workers by responding politely and professionally and being a valued team player - Exemplify extensive knowledge of the hospital revenue cycle with specialization in healthcare billing, follow-up, and the account resolution process to include claims submission, acceptance, and adjudication, transaction reviews, adjustment posting, identification of patient responsibility, etc. Required Knowledge and Skills: - Good analytical and math skills - Able to document problems and assist in their resolution - Demonstrated ability exceeding all established department/client quality and productivity standards - Proven ability to lead by example and foster mentoring relationships - Strong written and oral communication skills - Computer and internet literate in an MS Office environment - Ability to establish and maintain effective working relationships - US Healthcare Commercial and Managed Care Insurance Claim Management/Billing/Claim Edit Resolution - US Healthcare Medicare and Medicaid Insurance Claim Management/Billing/Claim Edit Resolution - US Healthcare Denials Management (technical and clinical) - Experience Level: 2 to 4 years - Shift timings: Flexible to work in night shifts (US Time zone) - Preferred Qualification: Bachelors degree in finance or any graduate.,