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Claims Representative at CareCore National, LLC in FRANKLIN, Tennessee

Posted in General Business 30+ days ago.

Type: Full-Time

Job Description:


Summary: Claims QA Auditor I - Responsible for ongoing improvement of quality standards to ensure accuracy and compliance for Claim Operations and Records Maintenance. Responsible for identifying and reporting inaccurate processes or quality issues. Collaborates with the Supervisor and SME related to claim audits, PSMND audits, and claim dispute audits. Ensure adherence to company policies in contract administration.

What You Should Have

  • Minimum Education, Licensure and Professional Certification requirement:
    • High school diploma or GED and two (2) + years of claims experience OR Associate's degree in related field and one (1) + years of claims experience is required

  • Minimum Experience required:

    • Must have 1-2 years claim adjudication experience

    • 1-2 years experience working with multiple health plans preferred

  • Required Skills: Excellent interpersonal communication skills both verbal and written. Strong organizational and analytical skills. Self-starter and proven team player with strong work ethic. Proficient with Microsoft office: Excel, Word, PowerPoint, and Outlook. Proficient with healthcare claim adjudication standards and procedures. Fast learner, ability to problem solve, reliability and punctuality is a must. Detailed-oriented with high degree of accuracy. Excellent investigative, problem resolution, judgment and decision-making skills required. Proficiency in Image One and MC400 preferred

Our Company and What We Offer

eviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. eviCore offers a variety of perks and benefits including, but not limited to:

  • Full medical, dental, vision, and vision benefits with employer funded HSA starting day 1

  • Strong work/life balance with 15 days of PTO (starting) per year plus paid holidays

  • Education assistance and tuition reimbursement along with ample opportunities for growth

  • Time away from work programs including employer paid short-term and long-term disability, caregiver leave, BTO (bought-time off) options, company paid volunteer community service hours, and more

  • Onsite fitness facilities, casual dress code- wear your jeans to work, and two comprehensive employee discount programs

  • Health coaching, Employee Assistance Program, resiliency and stress management solutions, Adoption Assistance Program and additional resources to support your well-being

  • Life & Accidental Death Dismemberment and additional Accidental Injury, Critical Illness, and Hospital Care Insurance

  • 401k retirement plan with company match of 50% employee contributions up to 6%

And so much more! Check out to see all of the perks and benefits we offer.