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Remote Case Research Services Associate

Conduent

Not Specified, United States Full-time in Healthcare & Medical
    • Job ID 1805911

    Job Description

    Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

    Remote Case Research Associate

    Schedule Mon- Fri 9:00am – 5:30pm EST

    Pay $17 to $20 per hour (Based on Experience)

    Job Description:

    The Case Research Associate III is responsible for completing the determination of the proper Coordination of Benefits when a member has two or more healthcare policies. Includes functions related to the accurate coordination of benefits, specifically, the order of the benefit determination including contacting other insurance carriers and members. This associate must have a knowledge base of healthcare eligibility, medical terminology, eligibility validation practices and coordination of benefits, including a working knowledge of CMS Medicare and NAIC guidelines. Associate must demonstrate a proven ability to gather information, answer questions, and resolve issues with coordination of benefits when multiple forms of coverage are available, namely, to understand and determine when Medicare or another other carrier should have been primary and not the plan. The role is expected to successfully operate within a remote environment, and with the appropriate support from team members, realize established company standards and key performance metrics related to the identification of members/claims in which the client plan payer paid but Medicare or another carrier should have paid primary.

    Job Responsibilities:

    • Reviews eligibility and other documentation to verify current payer order of benefits.

    • Provides expertise in COB and Third-Party Liability to review eligibility, investigates policy coverage to determine the proper order of benefits, and provides information that will lead to a successful payment or other appropriate account action. Interpreting and applying complex regulations.

    • Documents the findings of the correct order of benefit determinations in appropriate systems.

    • Communicate effectively with insurance companies, employer groups, members and providers via phone, email etc.

    • Manages all inbound and outbound call activity related to COB inquiries, initiating regular contact to other insurance companies, providers, members, employer groups, vendors and documents all corresponding findings.

    • Contact CMS to coordinate benefits and update validated eligibility records.

    • Process COB correspondence via mail and faxes

    • Provide Coordination of Benefit explanations and interpretations with expertise and within Federal regulations.

    • Analyzes and understands written communication from insurance companies, including an explanation of benefits.

    • Works through assigned inventories to meet productivity metrics assigned. Updates company systems with clear and accurate information such as point of contact and notes regarding contact from outbound and inbound calls.

    • Utilizes resources to ensure compliance with client requirements, HIPAA, and applicable federal or state regulations.

    • Achieves or exceeds established metrics and goals assigned, including but not limited to production and quality expectations. Ensuring timely and accurate completion of the COB tasks.

    • Contributes to continuous improvement of scripts, guidelines, and other tools provided to have professional conversations with Healthcare Insurance carriers, employers, and providers.

    • Ability to take high level direction.

    • Ability to work multiple projects simultaneously and meet deadlines.

    • Initiative-taker, self-directed, ability to work independently with minimal oversight.

    • Desire to make an impact, manage multiple tasks and shift priorities quickly.

    Qualifications:

    • Two years of medical based experience in either a provider, payer, or vendor environment (specifically involving Coordination of Benefits) OR 4 years of relevant experience (insurance verification, healthcare billing, claims, auditing, reimbursement, or data analysis).

    • Knowledge and understanding of the of Medicare CMS Federal and NAIC guidelines for coordination of benefits. Knowledge of medical terminology.

    • Excellent verbal and written communication skills. Competency in nonverbal, oral, and written communication; ability to identify, define and explain day-to-day problems and solutions.

    • Possess strong customer service skills, excellent communication skills, and be able to multi-task and prioritize. In addition, must have critical thinking skills and be highly organized.

    • Exercises self-awareness, monitors impact on others, is receptive to and seeks out feedback, uses self-discipline to adjust to feedback.

    • Strong Collaborator and team player.

    • Accountable for delivering high quality work.

    • Proven ability to work under high production and quality standards.

    • Strong computer skills with proficiency in Microsoft Office products including Word, Excel and Outlook.

    Pay Transparency Statement:

    Pay transparency laws in some locations require disclosure of compensation-related information. For this position, actual salaries will vary and may be above or below the range based on various factors, including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive.

    Furthermore, Conduent provides a variety of benefits to employees, including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation or sick time.

    The estimated salary range for this role is $17-20 per hour.

    Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

    People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the “Submit” button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form () . You may also click here to access Conduent’s ADAAA Accommodation Policy () .

    At Conduent we value the health and safety of our associates, their families and our community. For US applicants while we DO NOT require vaccination for most of our jobs, we DO require that you provide us with your vaccination status, where legally permissible. Providing this information is a requirement of your employment at Conduent.

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