Medical Claims processing

Understand and stay current with client contract criteria and requirements ensuring client services are compliant as well as meet client expectations. Ensure accuracy of claims processing and contract logic builds through internal audit processes. Perform targeted audits of claims processing including, but not limited to, high dollar payments, benefit matrix, interest payments, pre-payment and post-payment audits, and multiple procedure claims. Perform quality audits of claims staff, eligibility staff, and system logic. Perform audits of new client setup in the claims processing software. Run access queries as needed for administrative purposes. Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs. We offer comprehensive Medical, Dental, and Vision plans to keep you covered. Our 401(k) plan includes a 3% employer match to your 6% contribution. Guidehealth offers paid parental leave to give you the time you need.