Job Description

CLAIMS REPRESENTATIVE ADDRESS: Remote due to COVID-19. 2208 North Highway 121, Suite 210, Bedford, TX 76021 HOURS: Monday-Friday 8:00AM-5:00PM or 9:00AM-6:00PM PAY: $15.00-$17.00/hour paid every Friday (unknown until 1st submission) CONTRACT LENGTH: 01/04/2020 to 07/02/2021 (special project only, could lead to other opportunities OPENINGS: 9 PURPOSE: Elevated claims volume plus historical project work underway requiring additional capacity for processing and reviewing Texas Medicaid Claims. DUTIES:

• Delivers straightforward administrative and/or other basic business services in Claims.
• Examines and processes paper claims and/or electronic claims.
• Determines whether to return, pend, deny or pay claims within policies.
• Determines steps necessary for adjudication.
• Settles claims with claimants in accordance with policy provisions.
• Compares claim application and/or provider statement with policy file and other records to evaluate completeness and validity of claim.
• Interacts with agents and claimants by mail or phone to correct claim form errors or omissions and to investigate questionable entries.
• Issues tend to be routine in nature.
• Good knowledge and understanding of Claims and business/operating processes and procedures.
• Works to clearly defined procedures under close supervision.

SKILLS:

• Proficiency with computer applications including Microsoft Office, Internet, and email.
• Knowledge of Medicaid regulatory requirements and ability to work in dependently.
• Above average communication, interpersonal and negotiation skills required along with listening and written communication skills.
• Self-motivated and strong time management skills required.

EDUCATION:

• High School Diploma required
• Associate Degree preferred
• 1+ years’ experience processing Texas Medicaid claims
• 1+ years’ experience within QNXT software

Company Description

Tailored Management is a global staffing firm that specializes in partnering with large organizations that run their contingent labor program. We have the unique capacity to support programs across all scopes and geographic locations from a single headquarters, successfully elevating program performance across the board! We’re here to give you the resources and the opportunity to prove yourself and earn long-term, full-time career placement. In fact, many candidates who come through Tailored Management end up with a permanent offer from our clients within a year! We scan the nation for the best jobs available and then position you with the best tips, tools and career resources to make an outstanding impression. Let's get you that dream job!