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Claims Reconsideration Specialist - JHP at Thomas Jefferson University - ApplyBlast

Claims Reconsideration Specialist - JHP

Thomas Jefferson University

4 months ago

3.6 on Glassdoor

Philadelphia, PA

Onsite

Full Time

Junior

0 applicants

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About this role

A Claims Reconsideration Specialist at Jefferson Health Plans handles provider claim reconsideration requests and member billing complaints. The role involves resolving claims via correspondence and portals, processing adjustments, and conducting quality reviews using established guidelines. Specialists investigate pended claims, analyze adjudications, and recommend process improvements to ensure accurate documentation and timely resolution.

Responsibilities

Resolve provider claim reconsideration requests and member complaints timely
Process routine claim adjustments through MACESS application systems
Investigate pended claims and facilitate resolution within 72 hours
Conduct claim quality reviews according to established guidelines
Analyze adjudicated claims to recommend process improvements

Skills

Qualifications

High School DiplomaThree years of Claims processing experienceMedical billing experienceMedical coding experience

About Thomas Jefferson University

jefferson.edu

Headquarters

Philadelphia, Pennsylvania, United States

Company Size

10001+ employees

Founded

1824

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At Thomas Jefferson University in Philadelphia, PA, we are helping you to redefine what’s possible with innovative and tailored education opportunities.