We are hiring freshers
and experienced professionals to join our healthcare claims processing team as
a Bilingual Claims Resolution Specialist. This role requires fluency in
both English and Spanish (oral and written) to communicate effectively
with patients, employers, attorney representatives, insurance companies, and
other responsible parties in the United States. The specialist serves as a
liaison between key client contacts and end patients/employers/attorneys, primarily
through phone, email, and written correspondence.
Responsibilities
â Contact
end patients, employers, attorney representatives, insurance companies, and
other responsible parties in the US using both English and Spanish to gather
information required to complete claims.
â Analyze
and evaluate complex claim payments using the client's proprietary software,
systems, and tools.
â Use
payment documentation provided by payers to determine reimbursement status and
perform accurate and timely data entry.
â Conduct
timely and thorough telephone follow-up with payers and other responsible
parties to ensure claims and supporting documentation have been received and
facilitate prompt reimbursement.
â Prepare
complex claim initial bill packets, appeal letters, and related correspondence
in English and Spanish, as required, using the client's systems and tools.
â Assist
in obtaining supporting claim documentation, compiling billing packets, and
filing insurance claims accurately and efficiently.
â Translate
and interpret claim-related information and communications between English and
Spanish while maintaining accuracy and professionalism.
â File
and handle confidential documentation and Patient Health Information (PHI) in
compliance with HIPAA guidelines and company policies.
â Meet
or exceed monthly Quality Audit metrics and Production targets consistently.
â Collaborate
effectively with team members to improve operat