REMOTE Healthcare – Claims Quality Assurance Associate

Location: Remote
Categories: Customer Support & Administration
Req ID: 2021-51900

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Job Description

About Conduent

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on them.

You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Job Description

*Conduent is hiring REMOTE Healthcare- Claims Quality Assurance Associates*

We need a select few upbeat, articulate, computer/tech savvy, and reliable Claims Quality Assurance Associates to join our Team. You will conduct audits on the entire Life Cycle of Medical Claims:

  • Data Entry
  • Provider Add
  • Prepay
  • Post Pay
  • Adjustments/Corrected Claims
  • PDRs
  • Training: Will mirror work schedule
  • Work Hours – Flexible
  • Pay: $19/hourly – $20/hourly
  • Full Time – regular position [40 hours – overtime when needed by client]
  • Equipment provided
  • This a Remote / WFH position

Experience:

  • Medicaid / Medicare Claim Processing Experience

Hard Skills:

  • Microsoft Office 365
  • Excel (Proficient)
  • Microsoft Teams
  • SharePoint
  • Access Database

Soft Skills:

  • Quick Study
  • Positive
  • Excellent Communication and Documentation
  • Attention to detail
  • Organized

Requirements:

  • Must be at least 18 years of age with at least a high school diploma or GED.
  • Must pass a criminal background check.
  • Must have WIRED internet connection, WIFI is not permitted.

Plus:

  • Bilingual [Spanish / English]

Job Track Description:

  • Performs business support or technical work, using data organizing and coordination skills.
  • Performs tasks based on established procedures.
  • In some areas, requires vocational training, certifications, licensures, or equivalent experience.

General Profile

  • Expands skills within an analytical or operational process.
  • Maintains appropriate licenses, training, and certifications.
  • Applies experience and skills to complete assigned work.
  • Works within established procedures and practices.
  • Establishes the appropriate approach for new assignments.
  • Works with a limited degree of supervision.

Functional Knowledge

  • Has developed skillset in a range of processes, procedures, and systems.

Business Expertise

  • Helps teams to integrate and work together to support the achievement of company goals.

Impact

  • Impacts a team, by example, through the quality service and information provided.
  • Uses discretion to modify work practices and processes to achieve results or improve efficiency.

Leadership

  • May provide informal guidance to junior team members.

Problem Solving

  • Ability to problem solve, self-guided.
  • Evaluates issues and solutions to provide the best outcome for clients and end-users.

Interpersonal Skills

  • Clearly and effectively exchanges information and ideas.

Responsibility Statements

  • Creates a quality checklist to determine potential defects.
  • Reviews transactions and selects samples for auditing.
  • Performs risk assessments related to performance monitoring and financial operations.
  • Understands the connectivity of up-stream and down-stream processes with respect to the process they are auditing.
  • Validates audit findings with operations personnel to concur with root cause analysis (RCA).
  • Performs other duties as assigned.
  • Complies with all policies and standards.

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