GEMCORE
Healthcare
MedicalClaimsRepresentative
Neural analysis suggests this role is
optimal for entry candidates.
“Medical Claims Representative at GEMCORE. Skills: Claims analysis, Denial management, Process improvement. Analyze insurance payment differences. Analyze appeals”
Industry & Context.
Root cause analysis; Complex problem solving
What They're Looking For.
Must Have
1-2 years experience in consumer service or healthcare, Microsoft Outlook proficiency, Microsoft Excel proficiency, 30 WPM typing skills, Excellent telephone skills, Good cognitive reasoning ability, Detailed and thorough work orientation
Nice to Have
Clinical background helpful, Medical terminology knowledge helpful
What You'll Do.
Analyze insurance payment differences
Identify denial trends
Suggest process improvements
Collaborate with claims team
Communicate with department managers
Implement new procedures
Educate customers on healthcare products
Educate customers on deductibles
Educate customers on co-payments
Educate customers on third-party reimbursement
How You'll Work.
Team & Collaboration
Collaborate with claims team; Communicate with department managers
Full Job Description
GEMCORE’s continued success has earned us national recognition with Inc. Magazine’s list of America’s Fastest-Growing Companies and with the Cleveland Plain Dealer as a Top Workplace six years running! GEMCORE is a rapidly growing multi-state family of companies headquartered in Hudson, OH. Are you looking to begin or further your career in the medical supply industry where you are able to contribute to the success of the business, and build lasting relationships? All while allowing for personal time every evening, weekend, and holiday? Edwards Health Care Services (EHCS) , a division of GEMCORE , is a well-established and growing national direct-to home medical supply provider. We are seeking a highly motivated Medical Claims Representative to join our high energy team. The Medical Claims Representative's primary role is to determine the root cause of denials and payment delays. * We are a fast-growing company with advancement opportunities! * This position offers the ability to work unique problems and to apply complex problem solving skills. * This is a full-time, non-exempt, position. * Once training is complete, this position will potentially be part of a hybrid remote work schedule. This position is located in Hudson, OH. * Schedule is 8:00 am - 4:45 pm, Monday through Friday. * Employer paid vacation. * Benefits available include medical/dental/vision, life, short and long-term disability insurances, and 401K Retirement Savings Plan. Key Responsibilities * Analyze reports on insurance payment differences, appeals and rebills. * Work claim denials. * Identify denial trends and suggest process improvements. * Collaborate with claims team and communicate effectively with all other department managers in solving issues and implementing new procedures. * Proficient in the knowledge of healthcare products, deductibles, co-payments and third-party reimbursement for customer education and employee training purposes. ## Requirements Key requirements: * Self-starter wi
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