FULLY remote opportunity!
Description :
The claims resolution department handles all tricare claims that come through that don’t "process cleanly." A lot of claims are processed automatically if they are 100% correct.
The claims resolution team will review all of the claims that are not automatically processed due to something being off (wonky) or needing more information.
They will get trained on the most basic type of claim edit first which is finding valid beneficiaries to match to the claim.
A beneficiary is a person or a legal entity that is designated by you to receive a benefit (ex : the active duty member holds the policy but his family has tricare insurance as well;
they are the beneficiaries)
Need to research certain things- example - maybe the same name or social security is different, make sure they are paying attention to those details
MOST OF THE CLAIMS they are dealing with are beneficiary mismatches -
- misspelled name
- beneficiary not found
- provider submits the sponsors DOB instead of the beneficiary's DOB
Additional Skills & Qualifications :
- Ability to research on their own
- Strong computer skills - both data entry and navigation
- claims processing experience
About TEKsystems :
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity.
We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia.
As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change.
That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
Claims Processor- Remote
The claims resolution department handles all tricare claims that come through that don’t "process cleanly. The claims resolution team will review all of the claims that are not automatically processed due to something being off (wonky) or needing more information. A lot of claims are processed autom...
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