Job Description:

• Handle customer service inquiries and problems.
• Reviews pre-specified claims.
• Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process.
• Handles written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals.
• Ensures all compliance requirements are satisfied and that all payments are made against company practices and procedures.
• Identifies and reports possible claim over payments, underpayments and any other irregularities.
• Performs claim re-work calculations

**Previous medical claims experience and knowledge of medical terminology is preferred.

**Remote position

Our Mission:

Choice One Staffing Group offers our employees assistance in finding the best positions for their skills, talents, and experience. It’s simple.  At Choice One Staffing Group, People are our PURPOSE and YOUR success is OUR success!

Try us!  You’ll find we focus on providing a positive candidate experience from your first contact through the completion of your first assignment and every assignment.

Employee Benefits:

We offer medical, holiday pay, vacation pay, referral bonuses and pre-employment preparation.

Specialized Staffing:

We specialize in Administrative, Light Industrial, Technical, Medical and Hospitality

EEO Policy:

Choice One Staffing Group, Inc. is an equal opportunity employer that prohibits employment discrimination based on race, color, religion, sex, national origin and ancestry, individuals who are 40 years of age and older or qualified individuals with disabilities.