Claims Processor III - Remote

Are you ready to take a pivotal role in ensuring members receive the excellent care they deserve, all from the comfort of your home? Sentara Health Plan is actively seeking a dedicated and experienced Claims Processor III to join our team. This isn't just about processing papers; it's about being a vital link in our commitment to member satisfaction and smooth healthcare operations. If you're detail-oriented, have a passion for service, and thrive in a dynamic, remote environment, we invite you to explore this exciting opportunity.

Overview

Sentara Health is a leader in health plan services, committed to improving health every day. We are looking for a full-time, permanent Claims Processor III to contribute to our mission remotely. This role offers the flexibility of working from home with consistent hours, allowing for a great work-life balance.

Job Title: Claims Processor III
Company: Sentara Health
Status: Full-time, permanent position (40 hours per week)
Work Hours: Monday through Friday, 8 AM to 5 PM EST
Location: This is a fully remote opportunity available to residents in a wide array of US states including: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, and Wyoming.

Key Responsibilities

As a Claims Processor III, you will play an essential role in the administration of group information and member relations. Your day-to-day work will involve a variety of critical tasks, ensuring the seamless operation of our health plan. This includes:

Providing exceptional customer service related to member acquisition and retention for Sentara Health Plan.
Handling all aspects of group information administration.
Accurately processing claims with meticulous attention to detail.
Engaging directly with members, healthcare providers, and employers to resolve inquiries and ensure satisfaction.
Maintaining accurate records and ensuring compliance with all regulatory standards.

Requirements

To succeed in this role, we are looking for candidates who meet the following qualifications:

Education: High School Diploma or equivalent is required.
Certifications/Experience: Candidates must possess a CPC Certification OR a related Medical Certification OR have a minimum of 5 years of direct claims processing experience OR hold an Associate's degree or higher.
Technical Skills: Proficiency with standard office software and the ability to navigate various claims processing systems effectively.
Communication Skills: Excellent written and verbal communication abilities are essential for interacting with members, providers, and employers.
Attention to Detail: A strong commitment to accuracy and thoroughness in all tasks.
Work Environment: Must have a dedicated home office setup conducive to remote work, including a reliable internet connection.

What You'll Gain

Joining Sentara Health means becoming part of an organization dedicated to making a real difference in people's lives. You will experience a supportive culture focused on growth and well-being. This remote position offers the advantage of working from home while still being an integral part of a collaborative team. You will have opportunities to enhance your professional skills in a dynamic healthcare environment and contribute to a company that values its employees and the communities it serves.