We are looking for a driven and curious Claims Processing Executive (CPE) to join our growing dynamic
medical billing team. The ideal candidate will perform all activities involved in the preparation,
insurance verification and retrieval of medical records for US Workers’ Compensation claims. The CPE
will act as the liaison between key Client contacts and insurance companies primarily through phone.
Key Responsibilities:
- Analyse and evaluate worker’s compensation claim payments using client proprietary software,
systems and tools. Use payment documentation provided by payers to determine if the medical
provider has been reimbursed in compliance with the applicable state worker’s compensation
fee schedule and/or PPO contract.
- Research, request and acquire all pertinent medical records, implant manufacturer’s invoices and
any other supporting documentation necessary and then submit with hospital claims to insurance
companies to ensure prompt correct claims reimbursement.
- Conduct timely and thorough telephone follow-up with payers to ensure claims with supporting
documentation have been received and facilitate prompt reimbursement.
- Prepare correct Workers’ Comp initial bill packet or appeal letter using Client systems tools and
submit with all necessary supporting documentation to insurance companies.
- Other duties as required.
Required Skills:
- Bachelor’s Degree in any discipline.
- Preferred Experience working for a US based BPO OR US healthcare insurance industry
experience OR a similar experience recommended.
- Competent in MS Office Suite and Windows applications.
- Solid verbal communication skills.
- Fast and accurate typing skills while maintaining a conversation.
- Multitasking of data entry while conversing with Client contacts and insurance companies.
- Ability to professionally and confidently communicate to outside parties via phone, email and