Claims Representative - EviCore

📋 Description

• Review medical records, authorization documentation, and claim information to support post-service
• Verify member eligibility, benefits, coverage, authorization status, and applicable claim
• Build and maintain authorization cases, ensuring relevant clinical documentation is collected
• Process claims related to radiology, pain management, laboratory services, gastroenterology, and
• Adjudicate claims and process necessary adjustments based on authorization information and clinical
• Investigate and resolve claim discrepancies, missing information, and pending claim inventories to

🎯 Requirements

• High school diploma or equivalent required.
• Previous experience in medical claims processing, healthcare operations, or provider issue
• Working knowledge of medical terminology, CPT and ICD-10 coding, and health insurance claims
• Ability to interpret benefit plans, policy language, coverage requirements, and authorization
• Experience with claims management systems such as MC400, ICE, NASCO, and ImageOne is a plus.
• Proficiency in Microsoft Office applications, particularly Outlook, Excel, and Word.

🎁 Benefits

• Competitive hourly pay ranging from $17.75 to $24 USD, depending on experience, qualifications, and
• Eligibility to participate in an annual bonus plan
• Fully remote, work-from-home position within the United States
• Medical, dental, and vision insurance, effective from the first day of employment
• Access to behavioral health and wellness programs
• 401(k) retirement savings plan