Job Description
Overview:
TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide. Our client is an American multinational information technology services and consulting company and is a leading provider of information technology, consulting, and business process outsourcing services, dedicated helping the world's leading companies build stronger businesses.
Job Title: BPO TeamLead Operations - OPTLOP
Location: Phoenix,AR 85003
Duration: 6 Months
Job Type: Temporary Assignment
Work Type: Remote
Location: Phoenix,AR 85003
Duration: 6 Months
Job Type: Temporary Assignment
Work Type: Remote
Job Description:
- Join our team as a Claims Processing Executive in the healthcare sector where you will utilize your expertise in MS Excel to efficiently manage and process commercial claims.
- This remote position offers the flexibility of working from home during day shifts allowing you to balance work and personal commitments effectively.
- Your contributions will directly impact the accuracy and efficiency of our claims processing, enhancing customer satisfaction and operational excellence.
Key Responsibilities:
- Claims Processing: Review, validate, and process healthcare claims submitted by providers in accordance with insurance policies.
- Core platform QNXT claims experienced - Preferred
MUST HAVE CLAIMS and FACETS experience:
- Eligibility Verification: Confirm patient coverage, benefits, and pre-authorization requirements under Medicare, Medicaid, and private insurance plans.
- Adjudication: Approve, deny, or adjust claims based on payer guidelines and policy terms.
- Compliance: Maintain adherence to HIPAA regulations, CMS guidelines, and other healthcare compliance standards.
- Documentation: Record claim activity, maintain audit trails, and prepare reports for management.
Required Skills & Qualifications:
- High school diploma or equivalent REQUIRED
- Strong knowledge of healthcare insurance systems (Medicare, Medicaid, commercial payers).
- 2 4 years of experience in healthcare claims processing
- Familiarity with claims management software and EDI transactions.
- Excellent analytical, organizational, and communication skills.
- Ability to interpret insurance policies and payer guidelines.
- Detail-oriented with strong problem-solving abilities.
Competencies:
- Regulatory Knowledge Deep understanding of healthcare laws and payer requirements.
- Accuracy & Detail Orientation Ensures claims are processed correctly and efficiently.
- Prodblem-Solving Resolves claim disputes and denials effectively.
Years of Experience:
- 2.00 Years of Experience
TekWissen Group is an equal opportunity employer supporting workforce diversity.
Numbers & Facts
| Location | Phoenix, AZ (Remote) |
| Industry | Computer/IT Services |
| Salary | $19–$20 |
| Company Size | 100 to 499 employees |
| Year Founded | 2009 |
| Website | http://www.tekwissen.com/ |
About Company
WE THE TEKWISSEN PEOPLE
TekWissen offers you a broader portfolio of services, industry-leading solutions, and the meaningful innovations that give you greater flexibility and speed to respond to market dynamics, reduced costs and risk to improve enterprise performance, and increased productivity to enable growth.
To keep pace with global market demands, TekWissen keeps its finger on the pulse of change. Our organized approach to guiding a project from its inception to closure. Managing projects is becoming more and more important as we enter the digital era. To cope with the pace that this transition demands, a method is required to manage projects so they can yield quality work, while incorporating efficient use of time and resources.
Project involves identifying which quality standards are relevant to the project and determining how to satisfy them.
It is important to perform quality planning during the Planning Process and should be done alongside the other project planning processes because changes in the quality will likely require changes in the other planning processes, or the desired product quality may require a detailed risk analysis of an identified problem. It is important to remember that quality should be planned, designed, then built in, not added on after the fact.
Capabilities and accomplishments in one TekWissen business enhance the opportunity for success in the others. Put simply, TekWissen's unique combination of attributes promotes success.Skills
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